Sakarya Tıp Dergisi (Jan 2018)
An Unusual Hemorrhagic Shock Caused by Spontaneous Rupture of Hepatocellular Carcinoma: A Case Report
Abstract
Introduction: Spontaneous rupture of hepatocellular carcinoma (HCC) is a rare but fatal complication that can be occurred during follow up in advanced stages of chronic liver failure.Case Report: A 66-year-old male was admitted with tachycardia, fade and abdominal distention to the emergency clinic. The patient’s hemoglobin level was 5 mg/dl and the hematocrit value was 19 %.Abdominal contrast-enhanced computed tomography (CT) detected an extensive hematoma in the perihepatic area with a laceration of 37.7x35 mm in the dome of the liver extending from segment V to segment VIII. An emergent explorative laparotomy was performed in hemorrhagic shock status. The tumor mass was resected with negative surgical margins. Patient’s postoperative course was uneventful.Discussion: Spontaneous HCC rupture is a catastrophic situation which generally occurs suddenly and leads to coagulopathy, hemodynamic instability and liver failure. These patients have usually sudden abdominal pain, dizziness, confusion, fainting, tachycardia, and are often referred to emergency clinic with hemodynamic instability or in hemorrhagic shock status. Fall in hemotocrit levels is remarkable. Ultrasonography (USG) and CT is useful in detecting the ruptured liver mass, intraperitoneal fluid or hematoma. Resection of the ruptured tumor -if possible- should be considered. Transarterial chemoembolization (TACE) and Transarterial chemoembolization (TACE) are another alternative treatment options in selected cases where surgery is not suitable. Conclusion: Spontaneous HCC rupture is a serious life-threatening complication. If possible, resection of the ruptured tumor mass in emergency situations is not only lifesaving but also the treatment of choice of the primary disease.
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