Spontaneous Rupture of Hepatocellu- Lar Carcinoma and Hemoperitoneum- Management and Long Term Survival

Aims: Complications of HCC as spontaneous rupture and hemoperitoneum are life threatening and have been observed particularly in patients with superficially dislodged tumors with associated cirrhosis. Methods: Retrospective analysis of patients from hepatobiliary and liver transplantation units. Three cases for the past 15 years were found. Results: Of all three patients with ruptured HCC, one was operated in emergency because of positive abdominal punction for hemoperitoneum and active bleeding. In the other two patients, after emergency diagnostic US, CT and angiographic study, it was decided to perform selective embolization to stop bleeding and stabilize hemodynamic and in second stage proposed liver resection. The age of the patients at time of first accident was 36, 58 and 75, respectively two men and a woman. All patients were diagnosed with associated liver disease-cirrhosis. Diagnostic procedures and pathologic specimens showed superficially localization of ruptured tumoral nodules: predominantly in right liver lobe. The number of lesion was between 1 and 3, and in later stage, after progressing of the cancer process, it was diagnosed multiple. The mean size of tumor nodule was 3.0 cm. Three times repeated rupture was treated none surgically by chemoembolization. The 3, 5 and 10 year survival was 100%.