Hepatocellular Carcinoma With Small Bowel Metastasis and Intussusception: A Case Report and Literature Review.

[BACKGROUND] Hepatocellular carcinoma (HCC) is a common primary liver malignancy. Despite advancements in treatment, HCC often has a poor prognosis because of frequent recurrence and metastasis. Hematogenous metastasis to the gastrointestinal tract is uncommon, and metastasis to the small intestine is particularly rare.

[CASE] We report a case of a 72-year-old man with a history of hepatitis C virus and alcohol-related HCC. In 2017, he was initially managed with atypical hepatectomy of segments 5 and 6. He later developed bone and lung metastases, controlled by sequential systemic therapies. In early 2024, after undergoing a craniotomy for hemorrhagic occipital brain metastasis, he presented with diffuse abdominal pain, fullness, and vomiting. Imaging revealed distal ileal intussusception. A segmental small bowel resection was performed, and a fungating ileal tumor was identified as the lead point. Histology confirmed metastatic HCC (i.e., Hepar-1 positive). The postoperative course was uneventful, but within 3 months, new metastatic lesions appeared in the stomach and left breast; the latter was treated with a partial mastectomy.

[CONCLUSION] Small intestine metastasis from HCC, although rare, should be considered in patients with gastrointestinal symptoms or unexplained elevated tumor markers. Surgical resection is the most effective treatment approach, with minimally invasive and endoscopic techniques available for select cases.