scholarly journals Hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma in noncirrhotic liver. A case report and systematic review

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 739-744
Author(s):  
Nicola Tartaglia ◽  
Alessandra Di Lascia ◽  
Pasquale Cianci ◽  
Alberto Fersini ◽  
Mario Pacilli ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Spontaneous Rupture ◽  
Single Case ◽  
Relevant Literature ◽  
Arterial Embolization ◽  
Definitive Treatment ◽  
Prior History ◽  
Preliminary Treatment ◽  
Surgical Department ◽  
Noncirrhotic Liver

AbstractIntroductionHepatocellular carcinoma (HCC) is the sixth most common cancer. Spontaneous rupture of HCC is an acute complication with a high mortality rate. The HCC principally arises in the background of chronic liver disease and cirrhosis of the liver. In the last few years, the rising incidence of HCC in noncirrhotic liver suggests the presence of other factors that may play a role in liver carcinogenesis.MethodsWe reviewed all cases treated at the University Surgical Department of Ospedali Riuniti of Foggia from 2009 to 2018. Only a single case of hemoperitoneum caused by spontaneous rupture of HCC in noncirrhotic liver was found. An extensive search of the relevant literature was carried out using MEDLINE, and a total of 58 published studies were screened from the sources listed.ConclusionsThe management of this devastating emergency should be carefully analyzed, with stabilization of vital signs as soon as possible. Patient with ruptured HCC and hemoperitoneum without a prior history of cirrhosis and viral infections benefited from the role of transcatheter arterial embolization (TAE) as the preliminary treatment in order to have a more precise diagnosis and an optimal stabilization of the patient. Delayed or staged hepatectomy after TAE represents the definitive treatment.

scholarly journals Spontaneous Rupture of Renal Metastasis from Hepatocellular Carcinoma

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Osamu Kinoshita ◽  
Yusuke Ichijo ◽  
Masayuki Yoneda ◽  
Atsushi Ikai ◽  
Tetsuro Yamashita
Keyword(s):  
Hepatocellular Carcinoma ◽  
Spontaneous Rupture ◽  
Arterial Embolization ◽  
Detailed Examination ◽  
Retroperitoneal Space ◽  
Retroperitoneal Hemorrhage ◽  
Renal Metastasis ◽  
Hospitalization Period ◽  
Acute Back Pain ◽  
The Right

We report a rare life-threatening case of spontaneous rupture of renal metastasis from hepatocellular carcinoma (HCC) that was managed by emergent transcatheter arterial embolization (TAE). A 76-year-old woman diagnosed with HCC presented with acute back pain in her right side and was transferred to our hospital. Initial enhanced computed tomography revealed retroperitoneal hemorrhage from the right kidney, which was retrospectively diagnosed as a spontaneous rupture of the metastatic renal tumor from the primary HCC. Detailed examination identified an active retroperitoneal hemorrhage from the lesion and the patient’s condition became hemodynamically unstable; hence emergent TAE was performed. The hospitalization period after the TAE was uneventful and sorafenib was subsequently administered. Unfortunately, two months after the TAE, the tumor locally progressed within the retroperitoneal space. Tumors were controlled by repeated TAE as the patient did not want to undergo a nephrectomy. Consequently, she survived for more than one year after emergent TAE, exhibiting low levels of tumor marker. After rupture of the metastatic renal HCC, tumors were expected to progress into the retroperitoneal space, and nephrectomy was the next possible radical treatment to offer the best chance of long-term disease control.

Management of Spontaneous Rupture of Hepatocellular Carcinoma: Single-Center Experience

2001 ◽  
Vol 19 (17) ◽  
pp. 3725-3732 ◽  
Author(s):  
Chi-Leung Liu ◽  
Sheung-Tat Fan ◽  
Chung-Mau Lo ◽  
Wai-Kuen Tso ◽  
Ronnie Tung-Ping Poon ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Resection ◽  
Spontaneous Rupture ◽  
Therapeutic Approach ◽  
Transarterial Embolization ◽  
Definitive Treatment ◽  
Serum Total Bilirubin ◽  
Single Center ◽  
Two Stage ◽  
Second Stage

PURPOSE: To report the management of patients with spontaneous rupture of hepatocellular carcinoma (HCC) in a single center over a 10-year period and to evaluate a two-stage therapeutic approach. PATIENTS AND METHODS: A retrospective study was performed on all 1,716 patients with HCC who presented from 1989 to 1998. The two-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative method, hemostasis by transarterial embolization (TAE) or surgical means, followed by second-stage hepatic resection or transarterial oily chemoembolization (TOCE). Results of definitive treatment were compared with patients with no history of rupture during the same study period. RESULTS: During the study period, 154 patients (9%) had spontaneous HCC rupture. Initial intervention to control bleeding included TAE in 42 patients, surgical hemostasis in 35 patients, and conservative management only in 53 patients. The 30-day mortality rate was 38%. Independent factors on presentation affecting 30-day mortality were shock on admission, hemoglobin, serum total bilirubin, and known diagnosis of inoperable tumor. After initial stabilization and clinical evaluation, 33 patients underwent hepatic resection and 30 patients received TOCE. Median survival of the hepatectomy patients was 25.7 months; that of the TOCE patients was 9.7 months. Compared with patients with no rupture, survival after hepatectomy (25.7 months v 49.2 months, P = .003) was inferior but still substantially long, whereas survival after TOCE was comparable (9.7 months v 8.7 months, P = .904). CONCLUSION: Early mortality of spontaneous rupture of HCC was dependent on prerupture disease state, liver function, and severity of bleeding. Although it was a catastrophic presentation, prolonged survival could be achieved in selected patients with second-stage hepatic resection or TOCE.

scholarly journals Spontaneous Rupture of Hepatocellular Carcinoma in a Young Patient with Fatal Outcome

2018 ◽  
Vol 12 (1) ◽  
pp. 19-26 ◽  
Author(s):  
David F. Pinal-García ◽  
Carlos M. Nuño-Guzmán ◽  
Audrey Gómez-Abarca ◽  
Jorge L. Corona ◽  
Ismael Espejo
Keyword(s):  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Young Patient ◽  
Spontaneous Rupture ◽  
Liver Tumors ◽  
Transarterial Embolization ◽  
Fatal Outcome ◽  
Noncirrhotic Liver

Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially life-threatening complication. Diagnosis may be difficult, particularly in the absence of known liver cirrhosis or tumor. A 20-year-old male patient presented with progressive abdominal pain and shock. His past medical history was uneventful. Anemia, acute renal failure, and abnormal liver function test were demonstrated. Mild hepatomegaly, perihepatic and flank fluid, and multiple hypodense liver lesions suggestive of intrahepatic metastases or multifocal HCC were revealed by computed tomography. Two actively bleeding liver tumors and multiple tumors in a noncirrhotic liver were found. Hemostatic suture and perihepatic packing were performed. The patient remained in critical condition, with a fatal outcome 48 h later. Histopathologic analysis reported HCC and absence of cirrhotic changes. HCC spontaneous rupture incidence is reported between 2.3 and 26%. Median age is 65 years. No liver cirrhosis is found in one-third of patients, with a median age of 51 years. Sudden onset of abdominal pain and shock is observed in the majority of cases. An accurate preoperative diagnosis improves to 75% with ultrasound and computed tomography. Besides hemodynamic stabilization, there is no general agreement on the best treatment option. Transarterial embolization, surgical perihepatic packing, suture plication, and hepatic artery ligation are useful methods of hemostasis in unstable patients. Mortality has been reported from 16.5 to 100%. The histopathologic finding of HCC in a noncirrhotic liver represents a less frequent presentation. A case of spontaneous rupture of HCC carcinoma and a noncirrhotic liver in a young patient is herein reported.

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