Emergency laparoscopic resection of spontaneous rupture of hepatocellular carcinoma: A case report
| Autor: | Mohd Sharifudin Sharif, Allim Khairuddin, Guang Hong Ong, Syamim Johan, Firdaus Hayati, Jun Sam Tan, Vee Chuan Hoe |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Hepatocellular carcinoma medicine.medical_treatment Epigastric pain Article 03 medical and health sciences 0302 clinical medicine Case report medicine Hepatectomy Laparoscopy Rupture medicine.diagnostic_test business.industry Mortality rate food and beverages Emergency department medicine.disease digestive system diseases Surgery 030220 oncology & carcinogenesis Hemostasis Resection margin 030211 gastroenterology & hepatology business |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2019.11.055 |
| Popis: | Highlights • Ruptured hepatocellular carcinoma is associated with a significant morbidity and very high mortality rate. • Epigastric pain with hypovolaemic shock in addition to a raised serum alpha-fetoprotein can be suggestive of ruptured hepatocellular carcinoma. • One staged laparoscopic surgery can be considered among hemodynamically stable candidates with no ongoing bleeding and good functional liver reserve. Introduction Laparoscopic liver resection is currently performed as a therapeutic modality in hepatocellular carcinoma (HCC). In an emergency setting such as bleeding or rupture, however it has not been well documented. Presentation of case We describe a 55-year-old lady who presented to the emergency department with epigastric pain and symptoms of anaemia for one day duration. She was normotensive but tachycardic. Blood investigations revealed haemoglobin level of 6.5 g/dL and serum alpha-fetoprotein of 3136 g/dL. Contrast enhanced computed tomography scan revealed ruptured HCC of segment 2 and 3. She underwent emergency laparoscopic resection of the ruptured HCC. The postoperative recovery was uneventful and she was discharged well on postoperative day 7. Histology confirmed a 10 cm ruptured HCC with 3 mm tumour-free resection margin. Discussion Ruptured HCC is associated with a high mortality rate of 25–75 %. Traditional treatment involves initial stabilization and hemostasis through transarterial embolization followed by staged hepatic resection. However, laparoscopic liver resection has been shown to be superior than open surgery in terms of postoperative outcomes. Conclusion Laparoscopic resection of bleeding HCC is achievable and can be considered in the treatment algorithm of selected patients. |
| Databáze: | OpenAIRE |
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