Management of Spontaneously Ruptured Hepatocellular Carcinoma and Hemoperitoneum Manifested as Acute Abdomen in the Emergency Room

Hsueh, Kuan-Chun; Fan, Huiying; Chen, Teng-Wei; Chan, De‐Chuan; Yu, Jyh‐Cherng; Tsou, Shung-Sheng; Chang, Tzu-Ming; Hsieh, Chung-Bao

doi:10.1007/s00268-012-1734-6

Cited by 47 publications

(60 citation statements)

References 37 publications

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“…A study by Hsueh et al showed patients who received hepatectomy, either immediate or staged after posttransarterial embolization, and reported higher survival rates of 85.2% at 30 days and 62.2% at 1 year. By comparison, similar populations treated conservatively exhibited a reduction in liver function, prolonged INR, and increased 30-day mortality [15]. Contrary to the above study Leung et al in their retrospective study on 112 patients with ruptured HCC, comparing the in-hospital mortality and median survival in patients treated with conservative and surgical approach, concluded that the conservative approach gave similar results to that of surgical approach [(62% versus 51%) and (7 days' versus 12 days) resp.]…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Rupture of Hepatic Metastasis from Pancreatic Adenocarcinoma

Anil

Robin

Hiremath

2016

Case Reports in Oncological Medicine

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A 58-year-old man with advanced-stage pancreatic adenocarcinoma presented with fatigue and dyspnea. Examination revealed tachycardia (102 b/min) with mild tenderness in right upper quadrant. His hemoglobin (Hb) was 7.9 g/dL (10 days prior to presentation 12.2 g/dL), International normalized ratio (INR), platelet count was normal, and the stool guaiac test was negative. On admission, abdominal computed tomography (CT) scan showed hepatic metastatic lesion with a rupture and hemoperitoneum communicating to the subdiaphragmatic space. This rapid progression of anemia along with presenting symptoms and CT imaging were attributed to diagnosis of spontaneous rupture of liver metastasis from pancreatic adenocarcinoma. Patient received blood transfusion and hemoglobin was monitored in successive intervals. His general condition and anemia improved with conservative management and he was discharged in 3 days. Repeated CT after 4 months showed resolving hemoperitoneum and stable hemoglobin levels. The patient deceased 9 months after being diagnosed. A literature search revealed limited data regarding the incidence and management of spontaneous rupture of metastatic lesion secondary to pancreatic adenocarcinoma which has been managed conservatively and thus we are reporting our experience.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Rupture of Hepatic Metastasis from Pancreatic Adenocarcinoma

Anil

Robin

Hiremath

2016

Case Reports in Oncological Medicine

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“…Thus, the current TNM staging systems for HCC, namely, the fifth edition of the Liver Cancer Study Group of Japan (LCSGJ) classification [3] , and the seventh edition of the AJCC/ UICC (American Joint Committee on Cancer/Union for International Cancer Control) classification [4] , classify all ruptured HCCs as stage T4. On the other hand, recent reports have revealed that the mortality rate associated with ruptured HCC has decreased as a result of more rapid and accurate diagnosis, aggressive resuscitation and he-mostasis [5] . Surgical procedures have provided better outcomes than any other treatments for patients with ruptured HCC [5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, recent reports have revealed that the mortality rate associated with ruptured HCC has decreased as a result of more rapid and accurate diagnosis, aggressive resuscitation and he-mostasis [5] . Surgical procedures have provided better outcomes than any other treatments for patients with ruptured HCC [5][6][7][8] . Moreover, transcatheter arterial embolization (TAE) followed by elective hepatic resection has been considered an effective treatment [2,[9][10][11] ; on the other hand, one-stage resection could be recommended [12] .…”

Section: Introductionmentioning

confidence: 99%

An Analysis of Surgical Treatment for the Spontaneous Rupture of Hepatocellular Carcinoma

et al. 2015

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Background/Aims: The prognosis of spontaneous rupture of hepatocellular carcinoma (HCC) remains unclear. We investigated the prognosis of patients with ruptured HCC based on the treatments and prognostic factors associated with long-term survival. Methods: The prognoses of 64 consecutive patients treated for ruptured HCC from 1986 to 2013 were analyzed according to their methods of treatment. The prognostic factors of 16 surgical patients were identified, and their overall survival (OS) and recurrence rates were compared to 1,157 surgical patients who underwent surgery for non-ruptured HCC. The surgical outcomes were also compared using a propensity score matching method. Results: Surgery was associated with a better OS. Curative resection was the only independent prognostic factor in surgical patients with ruptured HCC (p = 0.040). Although the OS of surgical patients with non-ruptured HCC was found to be significantly better than that of the patients with ruptured HCC, no significant difference in OS was observed after propensity score matching. Conclusion: A curative resection should be the objective of treatment, assuming the suitability of the patient's clinical condition. When the liver function reserve and tumor extension of patients with ruptured and non-ruptured HCC are similar, then their surgical outcomes may not be significantly different.

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“…Some studies reported that TAE is effective in controlling bleeding from a ruptured HCC in the acute phase [46–48]. Hsueh et al reported that the prognosis of a ruptured HCC after TAE was better than that after conservative treatment and that TAE achieved successful hemostasis in 99% of patients [49]. For patients with ruptured FNH, TAE may be also effective in controlling bleeding in the acute phase.…”

Section: Discussionmentioning

confidence: 99%

Ruptured focal nodular hyperplasia observed during follow-up: a case report

et al. 2017

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BackgroundFocal nodular hyperplasia (FNH) is the second most common benign hepatic tumor and is very rarely complicated by hemorrhage or rupture. Although thought to be extremely rare, there have been several reports of hemorrhage caused by ruptured FNH. Herein, we report the case of a patient with ruptured FNH, who subsequently developed hemorrhage during follow-up.Case presentationA 32-year-old man was admitted to our department for an asymptomatic hepatic tumor in segments 4 and 5 (S4/5), which measured 8 cm in diameter and observed to project from the liver. Imaging and pathologic examination of a biopsy specimen confirmed the diagnosis of FNH. Three years after the diagnosis, the patient was readmitted to our hospital because of sudden onset of upper abdominal pain. Dynamic abdominal computed tomography revealed ascites around the tumor with high-density areas that were considered to represent hematoma caused by ruptured FNH. Transcatheter arterial embolization (TAE) was performed to stop the hemorrhage. One month after TAE, S4/5 of the liver was resected; macroscopic findings revealed that a large part of the tumor was composed of necrotic tissue and hematoma. Pathological examination using hematoxylin–eosin staining and immunohistochemical examination indicated a final diagnosis of FNH rupture and hemorrhage.ConclusionAlthough a well-established diagnosis of FNH usually requires no treatment or surveillance, careful examination remains necessary when the FNH is large and projects from the liver because of the possibility of rupture and hemorrhage.

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Management of Spontaneously Ruptured Hepatocellular Carcinoma and Hemoperitoneum Manifested as Acute Abdomen in the Emergency Room

Abstract: The treatment of ruptured HCC should be tailored to the individual case. Prolonged survival is possible in patients with preserved liver function through curative liver resection. Emergency physicians, radiologists, and surgeons play essential roles in managing these patients.

Cited by 47 publications

References 37 publications

Spontaneous Rupture of Hepatic Metastasis from Pancreatic Adenocarcinoma

Spontaneous Rupture of Hepatic Metastasis from Pancreatic Adenocarcinoma

An Analysis of Surgical Treatment for the Spontaneous Rupture of Hepatocellular Carcinoma

Ruptured focal nodular hyperplasia observed during follow-up: a case report

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