Spontaneous Rupture of Hepatocellular Carcinoma with Hemorrhagic Shock

Spontaneous rupture of hepatocellular carcinoma is a fatal and rare complication. Most of the patients admitted to the emergency department with abdominal pain and hemodynamic instability. After appropriate intravenous fluid therapy different treatment modalities can be chosen due to patient’s functional liver reserve, clinical status and tumor’s features.
A 48 years old male patient admitted to the emergency department with upper abdominal pain and severe hypotension. Dynamic contrast enhanced computerized tomography showed ruptured partially hypervascularized lesion at segment 4b and 5 in the liver. Also there were free hemorrhagic fluid densities at perihepatic and perisplenic areas. First of all transcatheter arterial embolization was performed at the interventional radiology department, then central hepatectomy including segment 5 and segment 4b was performed. The patient was discharged without any complication.
Ruptured hepatocellular carcinoma is an emergency clinical situation. Staged hepatectomy after transcatheter arterial embolization for ruptured hepatocellular carcinoma may be the best treatment option for patients who have acceptable liver functions and resectable tumor features.