Transarterial chemoembolization is a commonly used treatment modality for unresectable HCC. It involves the use of transarterial catheters to deliver local high doses of chemotherapy to the tumor. Often, particulate embolic agents are also administered with the chemotherapy to eliminate the arterial vascular supply of the lesion. Transarterial chemoembolization therapy can be quite effective in treating HCC, resulting in tumor response in 16% to 61% of patients.1Data on whether TACE offers a survival benefit to patients with HCC remains somewhat controversial.2Two randomized trials3,4have suggested that there is no survival benefit, while 2 other randomized studies have reported an improvement in survival following TACE.5,6Although TACE can usually be performed safely, it can be associated with complications. The most common complication is acute liver failure secondary to hepatic necrosis. Other complications include acute renal failure, encephalopathy, and gastrointestinal bleeding. More rare ischemic complications have also been reported, including hepatic and splenic abscess, gastric and duodenal ulcerations, and biliary stricturing. Often, these complications are attributed to leaking of chemoembolic agents into collateral vessels that supply other organs outside of the tumor bed with blood.7To our knowledge, this is the first reporting of a hepatogastric fistula following TACE therapy.