Successful endoscopic treatment of hepatoduodenal fistula formed during sorafenib treatment for hepatocellular carcinoma with duodenal invasion

Here, we have reported a case of hepatocellular carcinoma (HCC) with a duodenal fistula that was treated with endoscopic procedure in a 79-year-old female patient who was admitted to our hospital with melena. She was diagnosed with recurrent HCC with duodenal bulb invasion and hemorrhage. After 2 months of sorafenib treatment, an improvement in HCC was noted, while a hepatoduodenal fistula was detected at the invasion site. Hepatoduodenal fistula occurring in duodenal invasion of HCC often produces intractable infection and worsens prognosis. We successfully closed the fistula using argon plasma coagulation (APC), following endoscopic injection with fibrin glue and polyglycolic acid sheet coverage. Recent developments in chemotherapy for advanced HCC may provide similar cases with hepatoduodenal fistula occurring in duodenal invasion of HCC and endoscopic treatment could be one of the therapeutic options in such cases.