An Unusual Hemorrhagic Shock Caused by Spontaneous Rupture of Hepatocellular Carcinoma: A Case Report

Year 2017, , 235 - 239, 04.01.2018

Mehmet Aziret , Metin Ercan , Kerem Karaman , Necattin Fırat , Erdal Birol Bostancı Musa Akoğlu

https://doi.org/10.31832/smj.312274

Abstract

Introduction: Spontaneous rupture of hepatocellular carcinoma (HCC)
is a rare but fatal complication that can be occurred during follow up in
advanced stages of chronic liver failure.

Case Report: A 66-year-old male was admitted with tachycardia,
fade and abdominal distention
to the emergency clinic. The patient’s hemoglobin
level was 5 mg/dl and the hematocrit value was 19 %.Abdominal contrast-enhanced
computed tomography (CT) detected an extensive hematoma in the perihepatic area
with a laceration of 37.7x35 mm in the dome of the liver extending from segment
V to segment VIII. An emergent explorative laparotomy was performed in
hemorrhagic shock status. The tumor mass was resected with negative surgical
margins. Patient’s postoperative course was uneventful.

Discussion: Spontaneous HCC rupture is a catastrophic situation
which generally occurs suddenly and leads to coagulopathy, hemodynamic
instability and liver failure. These patients have usually sudden abdominal
pain, dizziness, confusion, fainting, tachycardia, and are often referred to
emergency clinic with hemodynamic instability or in hemorrhagic shock status.
Fall in hemotocrit levels is remarkable. Ultrasonography (USG) and CT is useful
in detecting the ruptured liver mass, intraperitoneal fluid or hematoma.
Resection of the ruptured tumor -if possible- should be considered.
Transarterial chemoembolization (TACE) and Transarterial chemoembolization (TACE)
are another alternative treatment options in selected cases where surgery is
not suitable.

Conclusion: Spontaneous HCC rupture is a serious life-threatening complication.
If possible, resection of the ruptured tumor mass in emergency situations is
not only lifesaving but also the treatment of choice of the primary disease.

Keywords

Hemorrhagic shock; hepatocellular carcinoma (HCC); Spontaneous HCC rupture; Surgical resection

Sıradışı Bir Hemorajik Şok Nedeni Spontan Hepatosellüler Karsinom Rüptürü: Olgu Sunumu

Abstract

Giriş:
Spontan
Hepatosellüler Karsinom (HSK) rüptürü nadir görülen mortalitesi yüksek bir
komplikasyondur ve genellikle kronik karaciğer
yetmezliğinin ileri evrelerinde ortaya çıkmaktadır.

Olgu
Sunumu: 66 yaşında erkek hasta spontan HSK rüptürü
nedeniyle acil serviste değerlendirildi. Hastanın hemoglobin 5 gr/dl ve
hematokriti % 19 idi ve hastada solukluk, şuur kaybı, batında
distansiyon ve taşikardi mevcuttu. Abdominal kontrastlı bilgisayarlı tomografi
(BT)’ de perihepatik alanda yaygın hematom ve karaciğer kubbede segment 5’ den
8’ e uzanan 37.7 x 35 mm ebatlarında laserasyon hattı
tespit edildi. Hasta hemorajik şok tablosunda idi ve exploratif laparotomi yapıldı.
Tümör negatif cerrahi sınırlar ile rezeke edildi. Hastanın postoperatif
takiplerinde sıkıntı olmadı ve taburcu edildi.

Tartışma:
HSK
rüptürü, koagülopati, hemodinamik instabilite, karaciğer yetersizliği ve
hemorojik şok gibi fatal komplikasyonlar ile karakterize katastrofik bir durumdur.
Tanı ve tedavisinin erken
yapılması hayatta kalımla yakın ilişkilidir. Tanıda genellikle kronik hepatitli
hastalarda ani gelişen karın ağrısı, karında şişlik, solukluk, hipotansiyon ve
taşikardi gibi hemorajik şok bulguları mevcuttur. Hematokritte ani düşüş tanı
koydurucu olabilmektedir. Ultrasongrafi ve BT rüptüre karaciğer kitlesi,
intraperitoneal sıvı veya hematomu göstermede faydalıdır. Rüptürü HSK’ nun
rezeksiyonu mümkünse önerilen tedavi yöntemidir. Seçilmiş ve cerrahi
yapılamayacak hastalarda transarteriyel kemoterapi (TAKE) yöntemi alternatif
yöntemdir.

Sonuç:
Spontan
HCC rupture hayatı tehtid eden ciddi bir durumdur. Acil durumlarda rüptüre
tümörün rezeksiyonu hem hayat kurtarıcı hem de primer hastalığın tedavi
seçeneğidir. 

Keywords

Hemorajik şok; Hepatosellüler Karsinom (HCC); HCC rüptürü; Cerrahi tedavi

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