Ruptured HCC Presenting as Acute Abdomen in a Non-cirrhotic Patient: a Diagnostic and Management Challenge

Abstract

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. HCC commonly develops in patients with pre-existing liver disease/cirrhosis. Hepatoma developing in non-cirrhotic/seronegative liver is rare and tends to present in advanced stage. Spontaneous rupture of tumor and hemoperitoneum is one of the dreaded complications of HCC. A 75-year-old non-cirrhotic gentleman presented with acute abdomen and was found to have a ruptured tumor in the liver during laparatomy. He was referred to us for further management after achieving hemostasis during primary surgery at peripheral hospital. Imaging revealed a ruptured tumor in segment IVA of the liver. He underwent left hepatectomy and had uneventful recovery. Though hemoperitoneum due to tumor rupture is a rare complication of HCC, it is associated with high mortality in the acute phase. Initial stabilization followed by curative hepatic resection would provide best option of long-term survival.