Öz
İntraperitoneal hemorajic rupture is a complication of hepatocellular carcinoma that can be mortal. Surgical management and arterial embolisation are the main therapy choices in selected cases. We presented a case of hepatocellular carcinoma with spontaneous rupture and intra-abdominal hemorrhage. A 70 years old male was admitted to emergency department with abdominal pain and unstable hemodynamy. Patient was taken the operation room due to intra-abdominal bleeding. İntraoperatif diagnosis was rupture haemorrhagic solid liver mass and they performed depacking and hemostasis. Then they decided to transport patient to our hospital (tertiary hospital). We perform depacking, liver segment resection (4b) and cholecystectomy operation. The histopathological examination for the resected specimen yielded the final diagnosis of welldifferentiated hepatocellular carcinoma. As in this case if there is not enough medical and technical equipment for curative surgery than after the first surgical intervention has been done transporting the patient to a tertiary hospital for curative surgery can be saving life.
Anahtar Kelimeler
Kaynakça
- Perz JF, Armstrong GL, Farrington LA. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006; 45: 529-38.
- Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: GLOBOCAN 2000. Int J Cancer 2001; 94: 153-6.
- Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2003; 362: 1907Vergara V, Muratore A, Bouzari H. Spontaneous rupture of hepatocellular carcinoma: Surgical resection and long-term survival. Eur J Surg Oncol 2000; 26: 770Nouchi T, Nishimura M, Maeda M. Transcatheter arterial embolization of ruptured hepatocellular carcinoma associated with liver cirrhosis. Dig Dis Sci 1984; 29: 1137-41.
- Hiroyuki Kirikoshi, Satoru Saito, Masato Yoneda. Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: A multicenter study. BMC Gastroenterology 2009; 30: 29.
- Zhu LX, Wang GS, Fan ST. Spontaneous rupture of hepatocellular carcinoma. Br J Surg 1996; 3: 602-7.
- Zhu LX, Geng XP, Fan ST. Spontaneous rupture of hepatocellular carcinoma and vascular injury. Arch Surg 2001; 136: 682-7.
- Vivarelli M, Cavallari A, Bellusci R. Ruptured hepatocellular carcinoma: An important cause of spontaneous haemoperitoneum in Italy. Eur J Surg 1995; 161: 881Pombo F, Arrojo L, Perez Fontan J. Hemoperitoneum secondary to spontaneous rupture of hepatocelluar carcinoma: CT diagnosis. Clin Radiol 1991; 43: 321-2. Polat KY, Akcay MN, Aydınlı B. Spontaneous rupture of hepatocelluler carcinoma: a case report and review of literature. Int J Clin Pract Suppl 2005; 103Tan FL, Tan YM, Chung AY. Factors affecting early mortality in spontaneous rupture of hepatocellular carsinoma. ANZ J Surg 2006, 76: 448-52.
- Liu CL, Fan ST, Lo CM. Management of spontaneous rupture of hepatocellular carcinoma: Single-center experience. J Clin Oncol. 2001; 19: 3725-32.
- Buczkowski AK, Kim PT, Ho SG. Multidisciplinary management of ruptured hepatocellular carcinoma. J Gastrointest Surg 2006; 10: 379-86.
Öz
Özet
Hepatosellüler karsinomun (HSK) intraperitoneal hemorajik rüptürü, ölümle seyredebilen bir komplikasyondur. Seçilmiş vakalarda ana tedavi seçenekleri cerrahi girişim ve arteriel embolizasyondur. Bu yazıda hepatosellüler karsinomun spontan rüptürü sonrası gelişen intraperitoneal kanamalı olgu sunulmuştur. Karın ağrısı ve hemorajik şok tablosunda dış merkezde acile başvurmuş 70 yaşında bir erkek hastadır. Karaciğerde intraperitoneal hemorajik rüptüre kitle nedeni ile sütür ile hemostaz ve packing ile ilk müdahalesi yapılan hasta daha sonra tarafımızca genel durumu ve vital bulguları düzeltilerek tekrar operasyona alınmış depacking sonrası karaciğer segment 4b rezeksiyonu ve kolesistektomi operasyonu yapılmıştır. Hastanın postoperatif dönemde patoloji sonucu iyi differansiye hepatosellüler karsinom olarak gelmiş olup bu olguda olduğu gibi yeterli tıbbi ve teknik ekipman olmadığında ilk cerrahi müdahale (sütürasyon ile hemostaz ve packing) sonrası ileri bir merkezde elektif cerrahi tedavi yaklaşımı da hayat kurtarıcı olabilir.
Anahtar sözcükler: Hepatosellüler karsinoma, spontan rüptür, tedavi
Abstract
İntraperitoneal hemorajic rupture is a complication of hepatocellular carcinoma that can be mortal. Surgical management and arterial embolisation are the main therapy choices in selected cases. We presented a case of hepatocellular carcinoma with spontaneous rupture and intra-abdominal hemorrhage. A 70 years old male was admitted to emergency department with abdominal pain and unstable hemodynamy. Patient was taken the operation room due to intra-abdominal bleeding. İntraoperatif diagnosis was rupture haemorrhagic solid liver mass and they performed depacking and hemostasis. Then they decided to transport patient to our hospital (tertiary hospital). We perform depacking, liver segment resection (4b) and cholecystectomy operation. The histopathological examination for the resected specimen yielded the final diagnosis of well-differentiated hepatocellular carcinoma. As in this case if there is not enough medical and technical equipment for curative surgery than after the first surgical intervention has been done transporting the patient to a tertiary hospital for curative surgery can be saving life.
Keywords: Hepatocellular carcinoma, spontaneous rupture, therapeutic
Anahtar Kelimeler
Kaynakça
- Perz JF, Armstrong GL, Farrington LA. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006; 45: 529-38.
- Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: GLOBOCAN 2000. Int J Cancer 2001; 94: 153-6.
- Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2003; 362: 1907Vergara V, Muratore A, Bouzari H. Spontaneous rupture of hepatocellular carcinoma: Surgical resection and long-term survival. Eur J Surg Oncol 2000; 26: 770Nouchi T, Nishimura M, Maeda M. Transcatheter arterial embolization of ruptured hepatocellular carcinoma associated with liver cirrhosis. Dig Dis Sci 1984; 29: 1137-41.
- Hiroyuki Kirikoshi, Satoru Saito, Masato Yoneda. Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: A multicenter study. BMC Gastroenterology 2009; 30: 29.
- Zhu LX, Wang GS, Fan ST. Spontaneous rupture of hepatocellular carcinoma. Br J Surg 1996; 3: 602-7.
- Zhu LX, Geng XP, Fan ST. Spontaneous rupture of hepatocellular carcinoma and vascular injury. Arch Surg 2001; 136: 682-7.
- Vivarelli M, Cavallari A, Bellusci R. Ruptured hepatocellular carcinoma: An important cause of spontaneous haemoperitoneum in Italy. Eur J Surg 1995; 161: 881Pombo F, Arrojo L, Perez Fontan J. Hemoperitoneum secondary to spontaneous rupture of hepatocelluar carcinoma: CT diagnosis. Clin Radiol 1991; 43: 321-2. Polat KY, Akcay MN, Aydınlı B. Spontaneous rupture of hepatocelluler carcinoma: a case report and review of literature. Int J Clin Pract Suppl 2005; 103Tan FL, Tan YM, Chung AY. Factors affecting early mortality in spontaneous rupture of hepatocellular carsinoma. ANZ J Surg 2006, 76: 448-52.
- Liu CL, Fan ST, Lo CM. Management of spontaneous rupture of hepatocellular carcinoma: Single-center experience. J Clin Oncol. 2001; 19: 3725-32.
- Buczkowski AK, Kim PT, Ho SG. Multidisciplinary management of ruptured hepatocellular carcinoma. J Gastrointest Surg 2006; 10: 379-86.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2014 |
| Yayımlandığı Sayı | Yıl 2014Cilt: 36 Sayı: 3 |