Les hépatocarcinomes rompus. À propos de 22 cas*

Abstract

Spontaneous rupture of hepatocellular carcinoma. Report of 22 cases.

Study aim: Spontaneous rupture of hepatocellular carcinoma (HCC) causing massive hemoperitoneum is a critical and life threatening complication. The study aim was to report a retrospective series of 22 cases observed in the same centre.

Patients and methods: From 1978 to 1998, 22 patients (18 males and four females, mean age: 63 years, range: 18–83) were treated for ruptured H.C.C involving a cirrhotic liver in 17 cases and a normal liver in five cases. In 14 cases, the diagnosis of acute hemoperitoneum indicated an immediate laparotomy. The site of rupture was predominant in the left lobe (eight cases). The surgical treatment was : left lobectomy (n=7), right hepatectomy (n=2), excision (n=4), hepatic artery ligation (n=5), direct hemostasis (n=4).

Results: Postoperative mortality was 45,4%. Among the 12 survivors, nine died within a delay of 6 to 29 months. Three patients were still alive at the time of this study at 32, 40 and 66 months.

Conclusion: Acute rupture of HCC requires emergency procedures with a high risk of mortality. Curative operation with hepatic resection is the most effective procedure but is not often feasible because of the spreading of the tumor or/and the cirrhosis. The ligation of hepatic artery seems to be an alternative procedure to obtain an immediate hemostasis. Fissuration allows performance of complementary explorations and possibly preoperative arterial embolization with better immediate results.