Combined approach for spontaneous rupture of hepatocellular carcinoma

Authors:
  • GAGian Luigi Adani
    Gian Luigi Adani
  • ARAndrea Risaliti
    Andrea Risaliti
  • UBUmberto Baccarani
    Umberto Baccarani
  • VBVittorio Bresadola
    Vittorio Bresadola
  • DLDario Lorenzin
    Dario Lorenzin
  • GTGiovanni Terrosu
    Giovanni Terrosu
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Abstract
Ruptured hepatocellular carcinoma is a rare, emergency occurrence in western countries with high mortality risk. A number of hypotheses have been formulated in order to explain the precise mechanism that leads to hepatocellular carcinoma (HCC) rupture: sub-capsular location, dimensions, portal hypertension, tumour necrosis, local increase of venous pressure due to the outflow reduction caused by neoplastic invasion, and the presence of a previous vascular injury which might predispose to HCC rupture. There is still a debate in the literature concerning the best approach in cases of HCC rupture. Surgery is the first option for treatment of acute abdominal bleeding. However the advent of endovascular treatments widens the range of possible therapies for acute bleeding control and subsequent ablation purposes. We report a case of hemoperitoneum from spontaneous rupture of undiagnosed HCC, that was treated successfully by emergency surgical resection followed by transarterial chemo-embolization for local recurrence.

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