Hepatocellular carcinoma rupture with haemoperitoneum

Case contributed by Dr Ian Bickle

Presentation

Five day history of abdominal pain, worse past 3 hours. No trauma. No medical history of note. Tachycardia. Low BP.

Patient Data

Age: 57
Gender: Male

Non contrast due to renal impairment. Limited solid organ evaluation.

Large volume haemoperitoneum in perihepatic and perisplenic distribution as well as in the pelvis.

8cm heterogenous lesion in segment 6 of the liver and a 3cm segment 7 low atteunation lesion. The former is at least partially composed of acute blood.

Aorta normal calibre.

Remaining solid organs normal.

Comment: Haemoperitoneum - in the context of no trauma and intrahepatic abnormalities this is most likely related to a primary liver lesion such as HCC with spontaneous haemorrhage and capsular rupture.

Selective coeliac, SMA and super selective right hepatic angiograms were performed.

This study shows irregular mass in segments 6 and 7 with evidence of tumour staining and neovascularity.

There is evidence of bleed from the segment 6 tumour with focal collection out side the liver margin.

Gastroduodenal artery, left gastric and splenic arteries are normal. Jejunal and ileal branches are normal.

Arterial portography shows portal vein is 1.02cm with normal flow in to the liver.

The right hepatic artery was embolized wih surgicel and the main artery was embolized with 4.0mm/3.0cmm steel coil.

Post procedure angiogram showed occlusion of hepatic artery.

Case Discussion

One uncommon, but recognised presentation of hepatocellular carcinoma, is with a haemoperitoneum.

Hepatocellular carcinomas are often vascular and may present late with an acute abdomen and haemodynamic instability, as in this case with a large volume haemoperitoneum.

Alpha feta protein was performed after the event and was elevated. AFP = 28 ng/ml.

The patient underwent catheter angiography and embolisation with resultant stablisaion of the haemodynamic parameters.

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Case information

rID: 45568
Case created: 30th May 2016
Last edited: 18th Nov 2016
Inclusion in quiz mode: Included

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