Spontaneous Rupture of Hepato­cellu­lar Carcinoma and Hemo­peritoneum-Management and Long Term Survival

Abstract

Aims:Complications of HCC as spontaneous rupture and hemoperitoneum are life threatening and have been observed particularly in patients with superficially dislodged tumors with associated cirrhosis.Methods: Retrospective analysis of patients from hepatobiliary and liver transplantation units. Three cases for the past 15 years were found.Results: Of all three patients with ruptured HCC, one was operated in emergency because of positive abdominal punction for hemoperitoneum and active bleeding. In the other two patients, after emergency diagnostic US, CT and angiographic study, it was decided to perform selective embolization to stop bleeding and stabilize hemodynamic and in second stage proposed liver resection. The age of the patients at time of first accident was 36, 58 and 75, respectively two men and a woman. All patients were diagnosed with associated liver disease-cirrhosis.Diagnostic procedures and pathologic specimens showed superficially localization of ruptured tumoral nodules: predominantly in right liver lobe. The number of lesion was between 1 and 3, and in later stage, after progressing of the cancer process, it was diagnosed multiple.The mean size of tumor nodule was 3.0 cm. Three times repeated rupture was treated none surgically by chemoembolization.The 3, 5 and 10 year survival was 100%.

Abandonment of surveillance, followed by emergency surgery for a second spontaneous rupture of hepatocellular carcinoma: A case report and review of the literature

“…In this report, we present a patient with not one but two almost identical occurrences of this complication. Reports of such patients are scarce and sparsely described in the literature . Furthermore, a literature search on rupture of HCC (Tables and ) was undertaken, and the following issues have been found worthy of emphasis.…”

Severe Anemia with Hemoperitoneum as a First Presentation for Multinodular Hepatocellular Carcinoma: A Rare Event in Western Countries

“…The hepatic artery supplied small tumors and it was drained by the portal vein. Thus, a tamponade effect was created if there is obstruction of the main branches of the portal vein and portal hypertension which eventually lead to tumor rupture [6]. When tumors have an encompassing fibrous capsule which grow expansively, intratumoral pressure can be elevated leading to rupture.…”

“…TAE is the first choice of treatment in unstable patient with active intra-abdominal hemorrhage with a success rate of 90% [6]. It improves hemostasis and outcomes.…”

“…Complications include repeated spontaneous rupture and intraabdominal HCC dissemination; however, it is not a contraindication for resection of primary tumor [6]. Prognostic factors to predict survival in the acute phase are serum bilirubin level, hemodynamic status on hospital admission, and prerupture disease state [8].…”

Hepatic Angiographic Findings of Ruptured Hepatocellular Carcinoma: "Sentinel Signs" versus Extravasation

“…In this study, an HCC that had not been ruptured at the time of the initial embolization due to a ruptured HCC was found to be ruptured one month later. In this setting, the capability of the vessel wall to resist stretching decreases, and the vessels readily split, causing hemorrhage and hematoma within the tumor, followed by tumor rupture (20,23,26). Based on this hypothesis, the sentinel signs described herein would be developed by the splitting and expansion of injured feeding arteries (sentinel vessels), which lead to extravasation of arterial blood into perivascular areas within the HCC (hypovascular areas and delayed dots).…”