Spontaneous Ruptured Hepatocellular Carcinoma; An Appraisal of Surgical Treatment

Abstract

Spontaneous rupture with bleeding is not an infrequent complication of hepatocellular carcinoma (HCC). From May, 1972 to January, 1987, 56 symptomatic patients with ruptured HCC were managed by plication of the lesion (2 patients), ligation of either the common hepatic artery, CHAL, (39 patients), or selectively, the arterial branch supplying the tumor-bearing lobe of liver, SHAL, (8 patients), and hepatic resection, HR, (7 patients). Effective hemostasis was achieved in 68.1% of patients with the use of hepatic artery ligation (HAL). SHAL provides a comparable control of bleeding but no demonstrable reduction of postoperative organ failure when compared with CHAL. The operative treatment employed had no influence on either the postoperative rates of morbidity, mortality, or survival. However, the rate of hospital mortality was high among the four patients who had emergency anatomical lobectomy, despite the absence of severe cirrhosis. Hepatic artery ligation, either CHAL or SHAL, is a satisfactory definitive hemostatic measure for unresectable HCC when it ruptured. SHAL is probably preferred to routine emergency HR for patients with potentially resectable lesions. Nonetheless, for selected patients with easily accessible lesions, segmentectomy or subsegmentectomy could still be contemplated in the absence of severe cirrhosis.

Intraperitoneal metastasis of hepatocellular carcinoma after spontaneous rupture: A case report

“…Open surgical method was the mainstay of treatment during 1960s-1980s. It was reported that various surgical procedures, including perihepatic packing, suture plication of bleeding tumors, injection of alcohol, hepatic artery ligation (HAL), and liver resection, are effective against hemostasis [10,[22][23][24][25][26] . Besides transarterial embolization (TAE) and transarterial chemoembolization (TACE) for palliative treatment in patients with unresectable HCC, TAE is also gradually used for hemostasis in spontaneous rupture of HCC.…”

Spontaneous Rupture of Hepatocellular Carcinoma

“…The variation in clinical presentations poses a challenge to clinicians in diagnosis and management. Various treatment options have been proposed, which include conservative treatment, 5 transarterial embolization (TAE), [6][7][8][9][10][11] different methods of operative hemostasis, 12,13 and emergency liver resection.…”

“…In their study, however, they excluded patients with coagulation defects, and some of these were successfully treated with conservative measures. Lai et al 13 advocated a policy similar to that used in our first period. They surgically explored 56 patients with an in-hospital mortality of 75%.…”

Ruptured Hepatoma: Report of 5 Cases in Arabs

“…Cases 3 and 5 had persistent vomiting for several hours before the onset of internal bleeding. Vomiting is an unusual symptom associated with ruptured liver tumours [2,12]. It seems likely that vomiting in these patients precipitated rupture.…”

“…All patients had advanced liver cirrhosis and radical surgery was not possible due to the advanced stage of the tumour. Because this condition is so uncommon, the diagnosis is rarely made pre-operatively, especially in a previously healthy patient [1,2,4,[6][7][8]12]. The diagnosis was made pre-operatively by abdominal ultrasonography only in 1 patient (case 5).…”