Abstract
Two cirrhotic patients with ruptured hepatocellular carcinoma (HCC), presenting with hemoperitoneum, were successfully treated by elective hepatectomy. Both of these patients, a 67-year-old female and a 76-year-old male, had first been taken to other primary hospitals by ambulance due to hypovolemic shock. They were then found to have a mass of approximately 5 cm in the cirrhotic liver. In the initial management, however, neither any direct hemostasis by surgery nor indirect measures such as transcatheter hepatic arterial embolization were performed in either case. Instead, conservative treatment consisting mainly of fresh blood and plasma transfusions were continued for more than a month until the liver function stabilized. In both hepatectomies, the use of a microwave tissue coagulator resulted in minimal intra-operative blood loss and an appreciably excellent post-operative course. These cases point to the effectiveness of a “wait and see” policy for selected patients with ruptured HCC.
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References
The Liver Cancer Study Group of Japan: Primary liver cancer in Japan. (1990) Ann Surg 211:277
Chearanai O, Plengvanit U, Asavanich C, Damrongsak D, Sindhvananda K, Boonyapisit S (1983) Spontaneous rupture of primary hepatoma: Report of 63 cases with particular reference to the pathogenesis and rationale of treatment by hepatic artery ligation. Cancer 51:1532–1536
Lai ECS, Choi TK, Fan ST, Wong J (1989) Spontaneous ruptured hepatocellular carcinoma: An appraisal of surgical treatment. Ann Surg 210:24–28
Satoh Y, Fujiwara K, Furui S, Ogata I, Oka Y, Hayashi S, Ohta Y, Iio M, Oka H (1985) Benefit of transcatheter arterial embolization for ruptured hepatocellular carcinoma complicating liver cirrhosis. Gastroenterology 89:157–159.
Ohtomo K, Furui S, Kokubo T, Yamauchi T, Yashiro N, Itai Y, Iio M (1988) Transcatheter arterial embolization for spontaneous rupture of hepatocellular carcinoma. Radiat Med 6(4):150–156.
Chen MF, Jan YY, Lee TY (1986) Transcatheter hepatic arterial embolization followed by hepatic resection for the spontaneous rupture of hepatocellular carcinoma. Cancer 58:332–335.
Ohta H, Nomoto M, Ozaki T, Vemura T, Ichida F, Soga K, Yamada T, Honma A, Shimizu T (1987) A clinical study of ruptured hepatocellular carcinoma (In Japanese). Nippon Shokakibyo Gakkai Zasshi (Jpn J Gastroenterology) 84:690–697.
Rikkers LF, Moody FG (1974) Estimation of functional hepatic mass in resected and regenerating rat liver. Gastroenterology 67:691–699.
Tani T, Taki Y, Jikko A, Minematsu S, Yamamoto M, Kamiyama Y, Tobe T, Ozawa K (1986) Short-term changes in blood ketone body ratio in the phase immediately after hepatic artery embolization: Their clinical significance. Am J Med Sci 291:93–100.
Gianopalo M (1989) Massimo B, Enzo S, Corrado M. Assessment of liver circulation by quantitative scintigraphy: Evaluation of the relative contribution of the hepatic arterial and portal venous blood flows to liver perfusion. Eur J Nucl Med 15:211–216.
Ong GB, Taw JL (1972) Spontaneous rupture of hepatocellular carcinoma. Br Med J 4:146–149.
Tabuse K, Katsumi M (1981) Application of a microwave tissue coagulator to hepatic surgery-the hemostatic effects on spontaneous rupture of hepatoma and tumor necrosis. Arch Jpn Chir 50:571–579.
Nagao T, Inoue S, Mizuta T, Saito H, Kawano N, Morioka Y (1985) One hundred hepatic resections-indications and operative results. Ann Surg 202:42–49.
Sonoda T, Kanematsu T, Takenaka K, Sugimachi K (1989) Ruptured hepatocellular carcinoma evokes risk of implanted metastases. J Surg Oncol. 41:183–186.
Nagasue N, Inokuti K (1979) Spontaneous rupture of hepatoma. Br J Surg 66:248–250.
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Inoue, S., Nagao, T., Wakabayashi, T. et al. Spontaneous rupture of hepatocellular carcinoma: An approach with delayed hepatectomy. Surg Today 22, 474–480 (1992). https://doi.org/10.1007/BF00308802
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DOI: https://doi.org/10.1007/BF00308802