Small intestinal metastasis of hepatocellular carcinoma diagnosed and resected as intestinal obstruction caused by a foreign body

Hematogenous metastases of hepatocellular carcinoma (HCC) to the small intestine are rare. In most cases, hematogenous metastasis is symptomatic, including perforation or bleeding, and the prognosis is poor. A 63-year-old man had lower right abdominal pain, and small intestinal obstruction due to chronic inflammation of the foreign body was suspected on computed tomography. Blood tests revealed elevated alpha-fetoprotein (AFP). He had undergone four surgeries for HCC. Conservative treatment was administered, but there was little improvement. A segmental resection of the small intestine was performed. A type 2 tumor was found in the resected specimen, and pathological examination led to a diagnosis of HCC metastasis in the small intestine. He survived without recurrence for 10 months after surgery. When a patient with a history of HCC treatment develops intestinal obstruction or intussusception, it is necessary to consider the possibility of small intestinal metastasis, especially if there is an increase in AFP.