Spontaneous rupture of hepatocellular carcinoma

Abstract

Spontaneous rupture of hepatocellular carcinoma (HCC) is a serious complication of the disease and often presents as a surgical emergency. The management of the condition remains a challenge to clinicians because of the associated major hemodynamic disturbance as well as underlying chronic liver disease. Successful management of ruptured HCC relies on prompt diagnosis, effective stabilization of the hemodynamic condition and effective hemostasis. Various surgical procedures have been employed for hemostasis. Hepatic artery ligation appears to be the most effective one and hemostasis can be achieved in about two thirds of the patients. Single-stage treatment with emergency hepatectomy was associated with an operative mortality of about 40%. A two-stage therapeutic approach including initial hemostasis with transarterial embolization or hepatic artery ligation followed by elective hepatic resection has been advocated. This approach has been reported to result in favorable survival outcome in selected patients.