HEMOPERITONEUM DUE TO SPONTANEOUS RUPTURE OF HEPATOCELLULAR CARCINOMA IN A NON-CIRRHOTIC PATIENT: PERIOPERATIVE REPORT

• DOI: https://doi.org/10.22533/at.ed.15952725290711

• Palavras-chave: Hemoperitoneum, hepatocellular carcinoma, spontaneous rupture, hepatectomy, non-cirrhotic liver.

• Keywords: Hemoperitoneum, hepatocellular carcinoma, spontaneous rupture, hepatectomy, non-cirrhotic liver.

• Abstract:

  Spontaneous rupture of hepatocellular carcinoma (HCC) is an uncommon and potentially fatal complication, most frequently described in cirrhotic livers. When it occurs in patients without known chronic liver disease, its diagnosis can be particularly challenging, given the low level of clinical suspicion.
  This is a 52-year-old male patient, a farmer from the interior of Ceará, who sought care with sudden, intense abdominal pain, accompanied by sweating and tachycardia. After initial hospitalization, he developed melena, a progressive drop in hemoglobin and the need for multiple transfusions. Upper digestive endoscopy did not identify an obvious source of bleeding, and abdominal CT scans showed a liver lesion in segment III, with characteristics suggestive of active bleeding. In the following 12 hours, there was a significant clinical deterioration with signs of hypovolemic shock, and exploratory laparotomy was indicated.
  During the operation, voluminous hemoperitoneum (approximately 2.5 liters) and a partially ruptured hepatic tumor lesion were found, located at the transition between segments II and III. Non-anatomical segmental hepatectomy was performed, with good post-operative progress. The histopathological study confirmed hepatocellular carcinoma in a non-cirrhotic liver. The patient was discharged from hospital in good clinical condition and continues to undergo satisfactory outpatient follow-up.