Acute Abdomen: A Rare Case of Ruptured Hepatocellular Carcinoma

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Abstract

Spontaneous ruptures of hepatocellular carcinoma (HCC) are rare. Nevertheless they may lead to difficult decisions in the emergency situation. The acute therapies include conservative treatment, transarterial embolization and surgery. Curative treatment of HCC can be achieved by liver resection solely. The decision-making depends on prognostic patient’s factors, such as hepatic viral infection status, Child-Pugh grade, liver cirrhosis and number of tumors. In this case transarterial embolization was preferable as a bridging therapy prior to further diagnostics and therapy, to lower the perioperative morbidity and mortality. The therapy of these cases needs an interdisciplinary approach to choose the best possible procedure in each case.

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Most cited references 8

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Spontaneous rupture of hepatocellular carcinoma: a systematic review.

Eric Lai, James Y W Lau (2006)

To review the management of spontaneous ruptured hepatocellular carcinoma in the acute phase, the definitive treatment after hemostasis, and the prognosis. A MEDLINE search was undertaken to identify articles in English from 1970 to 2004 using the key words "hepatocellular carcinoma," "spontaneous rupture," "therapeutic embolization," and "laparoscopy." Additional articles were identified by a manual search of the references from the key articles. There were no exclusion criteria for published information on the topics. All studies that contained material applicable to the topic were considered. In the acute phase, transarterial embolization for hemostasis has a high success rate (53%-100%). It has a lower 30-day mortality rate than open surgical methods (0%-37% vs 28%-75%). For the definitive treatment, staged liver resection has a higher resection rate (21%-56% vs 13%-31%) and a lower in-hospital mortality rate (0%-9% vs 17%-100%) than 1-stage emergency liver resection. Staged liver resection has a good survival rate (1-year survival, 54.2%-100%; 3-year survival, 21.2%-48%; 5-year survival, 15%-21.2%). Transarterial embolization is effective in controlling bleeding from ruptured hepatocellular carcinoma in the acute phase. The serum bilirubin level, shock on hospital admission, and prerupture disease state are important prognostic factors to predict survival in the acute phase. For definitive treatment, staged liver resection after attaining hemostasis is better than 1-stage emergency liver resection. Laparoscopy and laparoscopic ultrasonography may decrease unnecessary exploratory laparotomy, thus increasing the resection rate of previously ruptured hepatocellular carcinoma. Prolonged survival can be achieved in select patients with definitive treatment. It is still uncertain whether the long-term outcome of liver resection is the same for hepatocellular carcinoma with and without rupture when patients with the same tumor stage and liver functional state are compared.

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Growth rate of asymptomatic hepatocellular carcinoma and its clinical implications.

Jin-Chuan Sheu, Juei-Low Sung, Ding-Shinn Chen … (1985)

The growth rate of 31 asymptomatic hepatocellular carcinomas (diameter less than or equal to 5 cm) discovered in 28 patients by a prospective screening program was determined by real-time ultrasonography over 36-860 days. Except for one tumor that shrank on follow-up, the doubling time ranged from 29 to 398 days, with a median of 117 days, an arithmetic mean of 136 days, and a geometric mean of 110 days. In 17 tumors with more than two measurements, the growth rate remained exponential in nine, declined in growth in seven, and showed an initial lag period in one. Doubling time correlated with initial tumor diameter but was independent of the patient's age, sex, hepatitis B surface antigen status, tumor location, liver function tests, stage of liver cirrhosis, histologic type, or grade of malignancy. Although initial alpha-fetoprotein levels did not correlate well with growth rate, in 14 patients with an exponential increase of serum alpha-fetoprotein, the alpha-fetoprotein doubling time was closely related to the tumor doubling time. Based on the above data, the median detectable subclinical period of hepatocellular carcinoma was deduced to be 3.2 yr, and the suitable screening interval for its early detection in our area was 4-5 mo.

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

Haruki Sada, Masahiro Ohira, Tsuyoshi Kobayashi … (2016)

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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Author and article information

Journal

Journal ID (publisher-id): CRG

Journal ID (pmc): CRG

Journal ID (doi): 10.1159/issn.1662-0631

Title: Case Reports in Gastroenterology

Publisher: S. Karger AG

ISSN (Electronic): 1662-0631

Publication date Subscription-year: 2017

Publication date Collection: January – April 2017

Publication date (Electronic): 21 March 2017

Volume: 11

Issue: 1

Pages: 155-161

Affiliations

[_a] _aDepartment of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland

[_b] _bDepartment of Surgery and Orthopedics, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland

[_c] _cDivision of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland

[_d] _dInstitute of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland

[_e] _eDepartment of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland

[_f] _fDepartment of Surgery, Spital Linth, Uznach, Switzerland

Author notes

*Kai Oliver Jensen, Division of Trauma Surgery, University Hospital Zurich, Raemistrasse 100, CH–8091 Zurich (Switzerland), E-Mail kaioliver.jensen@usz.ch

Article

Publisher ID: 463378 Pmcid ID: PMC5478187 Other ID: Case Rep Gastroenterol 2017;11:155–161

DOI: 10.1159/000463378

PMC ID: PMC5478187

PubMed ID: 28638315

SO-VID: 5043e896-4274-4ae1-bb55-a911c51aec3a

License:

This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 30 January 2017

Date accepted : 13 February 2017

Page count

Figures: 4, Pages: 7

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