An Uncommon Case of Severe Gastric Ulceration Following Radioembolization for Hepatocellular Carcinoma: Clinical Insights and Management Challenges

Yttrium-90 trans-arterial radioembolization (TARE) is a locoregional therapy performed in select patients with hepatocellular carcinoma (HCC). Although generally well tolerated, the procedure can occasionally result in serious complications. We report the case of a 72-year-old Saudi woman with hypertension, hepatitis C-related cirrhosis, and recurrent HCC who underwent TARE after unsuccessful radiofrequency ablation. Following the procedure, she developed progressive epigastric pain and reduced oral intake. Endoscopy revealed a large gastric ulcer, and histopathology confirmed the presence of yttrium-90 microspheres within the mucosa, consistent with radiation-induced injury. Despite treatment with proton pump inhibitors and antacids, her symptoms persisted and required hospital admission. Her condition subsequently deteriorated with persistent ulceration and worsening liver function, leading to decompensation, sepsis, and death. This case illustrates a rare but severe adverse event following TARE and emphasizes the importance of careful preprocedural assessment and close monitoring. Clinicians should maintain vigilance for gastrointestinal complications in patients presenting with abdominal symptoms after TARE to allow timely recognition and management.