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Case Reports
. 2017 Mar 1;11(1):54.
doi: 10.1186/s13256-017-1199-1.

Liver radiofrequency ablation as emergency treatment for a ruptured hepatocellular carcinoma: a case report

Alessandra Bertacco  1   2 , Francesco D'Amico  3   4 , Maurizio Romano  1 , Michele Finotti  1 , Alessandro Vitale  1 , Umberto Cillo  1
Affiliations
Case Reports

Liver radiofrequency ablation as emergency treatment for a ruptured hepatocellular carcinoma: a case report

Alessandra Bertacco et al. J Med Case Rep. .

Abstract

Background: Hemoperitoneum is a possible complication of hepatocellular carcinoma that may require emergency surgery as an alternative to radiological locoregional therapies.

Case presentation: We present a case report of a 78-year-old white man with alcoholic-related cirrhosis and a multifocal hepatocellular carcinoma. An abdominal computed tomography scan showed multiple and bilateral foci of bleeding from broken liver cancer. He was urgently transferred from our radiology unit to our operating room for massive hemoperitoneum. A middle line laparotomy detected a massive hemoperitoneum. His liver was cirrhotic and completely subverted by a tumor; there were two spontaneous bleeding lacerations on segments II and IV, which were uncontrollable with conventional hemostatic techniques. Therefore, it was decided to carry out the coagulation of the multiple vascular afferents of each single mass by means of radiofrequency ablation cycles performed circumferentially on both nodules for a total of 40 minutes. Hemostasis was achieved; the radiofrequency ablation controlled the bleeding from his ruptured hepatocellular carcinoma. He was transferred to our intensive care unit for postoperative monitoring in terms of hemodynamic stability. On postoperative day 2 he was discharged from our intensive care unit.

Conclusions: Multifocal bleeding hepatocellular carcinoma still has an extremely high mortality. The angiographic control of multiple bilateral bleeding lesions can be extremely difficult and can be contraindicated by the location of the lesions and by the overall clinical condition of the patient. In this case, treatment with radiofrequency ablation has proven to be effective in the control of multiple and bilateral hepatic lesions. This particular technique allowed us to attack the lesion at the level of the vascular pedicle in order to control the bleeding.

Keywords: Case report; HCC ruptured; Liver bleeding; Radiofrequency ablation.

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Figures

Fig. 1
Fig. 1
Abdominal computed tomography scan with intraperitoneal fluid with blood density (a), and evidence of the contrast leak (white spread) in proximity of the right lobe of the liver (b)
Fig. 2
Fig. 2
Final result of bleeding control from ruptured hepatocellular carcinoma using radiofrequency ablation
See this image and copyright information in PMC

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