Damage Control Surgery for Hepatocellular Cancer Rupture in an Elderly Patient: Survival and Quality of Life.

Konstantinos Bouliaris,Alexandros Diamantis,Grigorios Christodoulidis,Dimitrios Symeonidis,Konstantinos Tepetes

doi:10.1155/2015/536029

Abstract

Spontaneous rupture of hepatocellular carcinoma (HCC) is a rare emergency condition with high mortality rate. Successful management depends on patients' hemodynamic condition upon presentation and comorbidities, correct diagnosis, HCC status, liver function, and future liver remnant, as well as available sources. There is still a debate in the literature concerning the best approach in this devastating complication. Nevertheless, the primary goal should be a definitive bleeding arrest. In most cases, patients with spontaneous rupture of HCC present with hemodynamic instability, due to hemoperitoneum, necessitating an emergency treatment modality. In such cases, transcatheter arterial embolization (TAE) should be the treatment of choice. Emergency liver resection is an option when TAE fails or in cases with preserved liver function and limited tumors. Otherwise, damage control strategies, as in liver trauma, are a reasonable alternative. We report a case of an elderly patient with hemoperitoneum and hypovolemic shock from spontaneous rupture of undiagnosed HCC, who was treated successfully by emergency surgery and damage control approach.

Highlights

Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease and cirrhosis and it is typically diagnosed late in its course
Diagnosis of ruptured HCC can be difficult especially when there is no history of HCC, cirrhosis, or HBV infection and the patient is in hemodynamic instability [5, 6]
transcatheter arterial embolization (TAE) has been increasingly used for hemostasis in ruptured HCC especially when there is hepatic insufficiency or liver cirrhosis [6, 10,11,12]

Summary

Introduction

Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease and cirrhosis and it is typically diagnosed late in its course. It is the sixth most common malignancy in the world and the third commonest cause of death from cancer [1]. Thirty-day mortality can be very high ranging from 32 to 75% [4] This poor outcome can be attributed to incorrect diagnosis, concomitant impaired liver function, advanced HCC status, inappropriate treatment, and patient’s general condition and comorbidities upon presentation. Patients with spontaneous rupture of HCC present with hemodynamic instability, due to hemoperitoneum, necessitating an emergency treatment modality. We present a case of a successful two-stage surgical treatment of a ruptured HCC in an elderly patient who presented with hypovolemic shock

Case Presentation

Findings

Discussion