Management of bleeding liver tumours in Hong Kong

Abstract

A retrospective study was undertaken of 41 patients diagnosed as having suffered spontaneous liver rupture over a 4-year period to identify the clinical features, treatment and outcome of this complication in an area in which hepatocellular carcinoma is endemic. Two patients were excluded with a revised diagnosis of haemorrhagic malignant ascites. Of the remaining 39 patients, 37 bled from ruptured hepatocellular carcinoma, one from peliosis hepatis and multiple liver cell adenomas, and one from a malignant hepatic epithelioid haemangioendothelioma. Analysis showed that 59 per cent of patients were in shock on admission and that all but two of the 37 patients with ruptured hepatocellular carcinoma were men with cirrhosis. The association with cirrhosis was significantly higher than in a series of 45 patients with hepatocellular carcinoma undergoing elective resection during the same period (P less than 0.05). Treatment consisted of supportive care only in two patients, angiographic embolization in four, emergency liver resection in 11 of whom six died, hepatic artery ligation in 12 of whom eight died, and suture and/or packing in eight of whom six died. One patient died at laparotomy and in another patient bleeding was successfully arrested by intratumoural injection of absolute alcohol. Because of the high operative mortality of emergency surgery in these poor risk patients, prospective evaluation of emergency angiographic embolization is required.

Management of Spontaneous Rupture of Liver Tumours

“…As previously reported in patients with HCC, bleeding from ruptured tumour is not necessarily exsanguinating nor progressive [1, 6]. In the present series, haemodynamic shock was present in less than 25% of our patients with ruptured HCC.…”

“…As reported in other studies, HCC with chronic liver disease and adenoma were the most frequent tumours at risk of spontaneous rupture [6]. …”

“…Rupture of hepatocellular carcinoma (HCC) occurs in about 10–15% [1]of patients while rupture is the mode of presentation of nearly 50% of patients with adenoma [2]. Because some patients may present with progressive abdominal distension and anaemia without haemodynamic decompensation while others present with hypovolaemic shock, accurate clinical diagnosis of spontaneous rupture of liver tumours is not easy.…”

Spontaneous Rupture of Hepatocellular Carcinoma

“…1999;134:1103-1107 H EPATOCELLULAR carcinoma (HCC) is common in areas with endemic viral hepatitis B and/or C. Rupture of HCC occurs in about 10% of patients. [1][2][3][4] It may occur as a terminal event in patients with advanced disease or it may be the first presentation in an otherwise healthy individual. Some patients may present with progressive abdominal distention and anemia without hemodynamic decompensation while others present with severe hypovolemic shock.…”

“…2 Patients were actively resuscitated with fluid and blood transfusion. Vital signs, central venous pressure, and urine output were closely monitored.…”