Ruptured hepatocellular carcinoma: Management options

Abstract

Background: Hepatocellular carcinoma (HCC) has endemic proportions in some regions of the world, including the Sub-Saharan Africa, China, and the Far East. One of its known complications is tumor rupture, with a bleak prognosis. Aim: This study aims to report on our experience with the management of ruptured HCC. Materials and Methods: We reviewed our records to retrieve cases of ruptured HCC, from September 2013 to December 2015. Results: We were able to identify five patients, all of them were males with a median age of 70 years (range 26). One patient had hepatitis B, three had Schistosoma, and the status of the fifth was undetermined. In one patient, who eventually died, an emergency laparotomy deemed necessary to control the bleeding. In the other four, who were stabilized to undergo computerized axial tomography scan, angioembolization of the tumor feeding vessels succeeded to arrest the bleeding. Unfortunately, two patients died shortly after the procedure, while the other two survived and were discharged for follow-up. Conclusion: Spontaneous rupture of HCC is a grave event with a dismal prognosis. The optimal management should be individualized, based on the condition of the patient, the tumor characteristics, the facilities, and expertise available. Close collaboration between the interventional radiologist, gastroenterologist, oncologist, and surgeon is fundamental for success. The emergency laparotomy may be the appropriate action for the unstable patients. For those who could be stabilized, angioembolization with or without chemotherapy is an attractive option. Conservative treatment may be reserved for those with the worst prognosis.