A case of hemorrhagic duodenitis treated with argon plasma coagulation (APC) in hepatocellular carcinoma after proton beam radiation

Proton beam radiation is an effective treatment method for hepatocellular carcinoma. Radiation-induced duodenitis with severe hemorrhage is rare side effect by proton beam therapy. We report a case of hemorrhagic duodenitis caused by proton beam therapy for hepatocellular carcinoma, which was treated successfully with APC. A 65-year-old man, who had liver cirrhosis due to hepatitis C virus, was diagnosed hepatocellular carcinoma of right anterior segment. He received proton beam radiation. Three months later, he suffered anemia and hematochezia. Hemorrhagic duodenitis caused by proton beam radiation was found. We performed APC two times for hemorrhage from duodenitis. After the treatments, the patient had no relapse of hemorrhagic duodenitis for ten months until his death of hepatocellular carcinoma.