Spontaneous Rupture of Hepatocellular Carcinoma in a Young Patient with Fatal Outcome

Abstract

Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially life-threatening complication. Diagnosis may be difficult, particularly in the absence of known liver cirrhosis or tumor. A 20-year-old male patient presented with progressive abdominal pain and shock. His past medical history was uneventful. Anemia, acute renal failure, and abnormal liver function test were demonstrated. Mild hepatomegaly, perihepatic and flank fluid, and multiple hypodense liver lesions suggestive of intrahepatic metastases or multifocal HCC were revealed by computed tomography. Two actively bleeding liver tumors and multiple tumors in a noncirrhotic liver were found. Hemostatic suture and perihepatic packing were performed. The patient remained in critical condition, with a fatal outcome 48 h later. Histopathologic analysis reported HCC and absence of cirrhotic changes. HCC spontaneous rupture incidence is reported between 2.3 and 26%. Median age is 65 years. No liver cirrhosis is found in one-third of patients, with a median age of 51 years. Sudden onset of abdominal pain and shock is observed in the majority of cases. An accurate preoperative diagnosis improves to 75% with ultrasound and computed tomography. Besides hemodynamic stabilization, there is no general agreement on the best treatment option. Transarterial embolization, surgical perihepatic packing, suture plication, and hepatic artery ligation are useful methods of hemostasis in unstable patients. Mortality has been reported from 16.5 to 100%. The histopathologic finding of HCC in a noncirrhotic liver represents a less frequent presentation. A case of spontaneous rupture of HCC carcinoma and a noncirrhotic liver in a young patient is herein reported.

Spontaneous Rupture of Hepatocarcinoma in a Patient without Previously Known Liver Disease

“…We must consider that hemangiomas, adenomas and hepatocarcinomas are the 3 hepatic neoplasms most likely to present this picture [14], the urgent laparotomy being necessary in most of the occasions before the seriousness with which they appear. Despite the aforementioned, there are reports with a small percentage of hepatocarcinoma on healthy livers, where the clinical manifestations are usually nonspecific and usually go unnoticed in patients who are outside the age range of presentation, which generally ranges from 60 to 70 years of life [15]. Patients with no relevant personal history for the suspicion of malignancy should be screened with histopathological reports, and, as explained in the present case, immunohistochemical complementation.…”

“…The low frequency of presentation of spontaneous hemoperitoneum from liver tissue in patients without a history of hepatopathy, and in whom the origin has been ruled out in other organs, forces us to control hemorrhage at an early stage by emergency laparotomy, with the initial goal is homeostasis [15] for maintaining the hemodynamic stability and prevention of the triad of death, and a definitive control was subsequently carried out with the necessary resources for the planned surgical approach. In view of the statistical increase in hepatocellular carcinoma in our environment, it is necessary to consider taking biopsies for histopathological study and the follow-up of cases where there are discrepancies regarding antecedents, presentation and transoperative findings, since the omission of this can lead to unnoticed diagnosis, with the risk of early invasion of ruptured tumors, which is one of the factors that negatively influence the short-term prognosis and survival of patients [16], which shows the aggressive nature and poor forecast before this form of presentation [17,18].…”

Gastrointestinal Bezoars in Paediatrics

“…Trichobezoars constitute <6% of bezoars affecting females in 20s and 30s. [ 4 5 6 ] Trichotillomania and trichophagia are associated in 10% of cases having trichobezoars. [ 7 ]…”

Gastrointestinal Bezoars in Pediatrics: Case Series and Literature Review

“…[3] Trichobezoars constitute 6% of all bezoars cases in humans which mostly affect females in the twenties and thirties of life with a rarity in pediatrics. [4][5][6] Trichotillomania (hair pulling) and trichophagia (hair eating) are commonly associated in about 10% of cases presenting with trichobezoars. [7] Abdominal pain, nausea, vomiting, weight loss, constipation, Small bowel obstruction, occasional hematemesis with a palpable mass are commonly found in these patients.…”