Introduction: Hepatocellular carcinoma (HCC) is the commonest primary tumor in the liver. It has been shown to have a strong association with hepatitis B and C. HCC not only commonly metastases to the other part of the liver but also commonly metastases to the lung. Involvements of upper gastrointestinal organs are rare. We report a case of hepatocellular carcinoma with duodenal metastases. Method: A 58 years old Chinese man with a background history of hepatitis B presented with right hypochondrium pain. No jaundice or any constitutional symptoms noted. Physical exams revealed irregular right hypochondrium mass. No ascites palpable. Most blood investigation was unremarkable except for a raised Alpha fetoprotein of 2920. Imaging studies confirmed a diagnosis of a segment 4B HCC with enlarged portal nodes and left portal vein thrombosis. Despite his Child�s score A, he was deemed inoperable and subjected to chemoembolization. During a subsequent follow up, he developed symptomatic anaemia with hemoglobin level of 6.2 g/dl. He developed multiple episodes of anaemia and Upper GI endoscopy shows a bleeding tumor at first part of duodenum extending to the second. Biopsy revealed as metastatic HCC. Results: Conclusions: Hepatocellular carcinoma is known to spread via haematogenous, lymphatics or trancoelomic. The usual sites of metastases are lung, regional lymph nodes and bones. Metastases via direct spread are uncommon hence the rarity of metastases to other upper gastrointestinal organs especially small bowel. This presentation imposed a treatment dilemma due to the limited approach to both primary and the metastases lesion.

Advanced hepatocellular carcinoma carries a bad prognosis with a survival of only few months. Barcelona Clinic Liver Cancer (BCLC) Guidelines recommended sorafenib monotherapy as the treatment modality for advanced BCLC Stage C disease, citing a two-month increase in survival rates. Here, we highlight a case with advanced HCC (BCLC Stage C) treated with combination therapy of liver resection and Sorafenib therapy. The patient's current survival rate was beyond 10 months. We also discuss the current evidence on liver resection with Sorafenib therapy in hepatocellular carcinoma. The description of the case may benefit in future diagnosis and treatment.

Intussusception is common cause of bowel obstruction in the paediatric age group compared to the elderly population. Many times, the diagnosis may be difficult because of asymptomatic nature of this bowel disorder. We hereby describe the case of a 75-year-old male who presented with lethargy, weakness, loss of movement in the joints and was found to be anemic. The haemoglobin level was low so he was transfused with packed cells. On gastrointestinal (GI) endoscopy, upper GI bleed was observed. A mass was observed beyond ampulla at the 2nd and 3rd part of the duodenal junction. Computerized tomography (CT) scan also showed a mass at the head of pancreas and the lesion at the left lung. In view of persistent bleed, 'Whipple's procedure' was performed. Histopathological examination showed small cell carcinoma of the lungs with metastasis to the pancreas and the jejunum. We here discuss the case of intussusception with intestinal metastasis which presented with gastrointestinal bleeding.