Spontaneous Rupture of Hepatic Metastasis from Pancreatic Adenocarcinoma

Abstract

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.

The Diagnostic Dilemma of Ruptured Liver Metastasis in a Patient with Lung Cancer

“… 15 On the contrary, a retrospective study on patients with ruptured HCC and a case report on ruptured liver metastasis in a pancreatic adenocarcinoma were managed successfully with conservative management. 14 , 16 Similarly, in the present case, the patient was managed conservatively but had a poor outcome.…”

“…12,13 Diagnosis of non-small cell lung carcinoma is based on histopathology with immunohistochemical markers such as Treatment of spontaneous rupture of hepatic metastasis depends on the tumour as well as the patient factors such as the tumour size, location, severity of bleeding, active bleeding and hemodynamic stability of the patient. 3,14 There are various treatment modalities available for ruptured liver metastasis ranging from conservative to surgical resection. A staged approach is advocated in recent studies where the active bleeding is managed by less invasive Trans-arterial angioembolization (TAE), hepatic wedge resection, lobectomy, or suture ligation of the bleeder followed by hepatic resection.…”

“…A staged approach was advocated in a recent report where the active bleeding is managed by less invasive trans-arterial angioembolisation (TAE), hepatic wedge resection, lobectomy or suture ligation of the bleeder followed by hepatic resection. 14 Conservative management of ruptured liver metastasis focuses on correcting coagulopathy, close-monitoring and stabilisation of the patient followed by imaging to confirm haemostasis. There are conflicting studies regarding the conservative management in the literature.…”