Fatal Haemoperitoneum from Ruptured Hepatic Metastases from Testicular Teratomas

Abstract

Fig. Intravenous urogram (post-micturition film) showing dilatation of the right lower ureteric segment with suspicion of a space-occupying lesion.and Mitchell, 1973), particularly when it occurs in only one limb of an incompletely duplicated ureter. Haematuria with a dilated ureter in one limb should alert the urologist to 'the diagnosis even if this warrants a laparotomy. Difficulty in diagnosis appears to be the rule rather than the exception (Bloom etal., 1970). References Bloom, N. A., Vidone, R. A. and Lytton, B. (1970). Primary carcinoma of the ureter: a report of 102 new cases. J. Urol., 103,59@598. Williams, C. B. and Mitchell, J. P. (1973). Carcinoma of the ureter-a review of 54 cases. Br.

Hemoperitoneum secondary to bleeding of a hepatic metastasis of testicular carcinoma

“…Like the other reported cases of hemoperitoneum due to hepatic metastasis rupture of testicular tumors, this complication is more common with aggressive cancers, such as choriocarcinomas, embryonal carcinomas, or mixed carcinomas with any of these two components, as in this patient's histology [5, 6]. On the other hand, hemoperitoneum could occur spontaneously or after chemotherapy.…”

Spontaneous rupture of hepatocellular carcinoma with haemoperitoneum: a rare condition in Western countries

“…Hepatic enzymes may be elevated [15]. Although red cell Tc‐99m scintigraphy [16] and CT can help to identify the source of intra‐abdominal bleeding [5,17,18], these occult malignancies are usually diagnosed during operation [13] or at autopsy [15,19,20].…”

“…Both primary and metastatic tumours can be highly vascular and necrotic [13,15,19] and therefore prone to intraperitoneal rupture. Factors that contribute to bleeding may include increased intravascular pressure secondary to tumour embolus [20], causing intrahepatic venous obstruction with shunting of blood [19,21], and a hyperaemic liver circulation [22] caused by proximity of vessels to metastatic nodules or primary tumours. However, direct pressure of the tumour against the capsular surface of the liver seems the most plausible explanation [13].…”

A Life-Saving Cancer: More on the Double Whammy

“…13,16,17 Finally, metastatic lesions in the liver rarely rupture spontaneously and cause massive hemoperitoneum. [19][20][21][22][23][24] The primary tumors in such cases are diverse in location and cell type.…”