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Case Report

Spontaneous rupture of hepatocellular carcinoma

Amer Hawatmeh , Khalid Jumean , Ahmed Abu Arqoub , Hamid Shaaban 2
1
1
1
1 Department of Internal Medicine, St. Michael’s Medical Center, Newark, NJ 07102, USA.
2 Department of Internal Medicine, Hematology and Oncology, St. Michael’s Medical Center, Newark, NJ 07102, USA.

ABSTRACT
This is a very interesting case of a 64-year-old female with a history of chronic hepatitis C infection, with abdominal pain and
was found to have ruptured hepatocellular carcinoma (HCC). She was managed with the two-stage therapeutic approach first
using transarterial embolization to provide adequate hemostasis and then surgical resection with an excellent outcome. This
case report exemplifies the importance of early diagnosis and treatment of ruptured HCC.
Key words: Hepatocellular cancer; rupture; transarterial embolization

Address for correspondence:
Dr. Hamid Shaaban, Department of Internal Medicine, Hematology and Oncology, St. Michael’s Medical Center, Newark, NJ 07102, USA.
E-mail: hamidshaaban@gmail.com
Received: 20-06-2015, Accepted: 19-11-2015

INTRODUCTION with worsening right upper abdominal pain for the last few
months; the symptoms continued to progressively get worse
Hepatocellular carcinoma (HCC) is the most common until her presentation to the emergency department. Initial
primary malignant tumor of the liver, and one of the leading vital signs showed blood pressure of 140/76 mmHg, pulse
causes of death in patients with cirrhosis. Spontaneous rate of 74 beats/min, respiratory rate of 18 breaths/min, and
rupture is a fatal complication of HCC that occurs in 3-15% oxygen saturation of 98% on room air. Physical examination
of cases and is associated with worse short- and long-term showed significant right upper quadrant tenderness, soft
prognosis. [1-3] In this case report, we are presenting a case abdomen with no guarding or rigidity and active bowel
of a 64-year-old female with a history of chronic hepatitis sounds, normal heart sounds with no murmurs or added
C infection who presented with abdominal pain and was sounds, and normal breath sounds. Initial lab results showed
found to have a ruptured HCC. She was managed with the a white blood cell count of 7.4 k/μL, hemoglobin of 14.2 g/
two-stage therapeutic approach first using transarterial dL, hematocrit of 42.8%, platelets of 177 k/μL, creatinine of
embolization (TAE) to provide adequate hemostasis and 0.89 mg/dL, aspartate aminotransferase of 30 IU/L, alanine
then surgical resection with an excellent outcome. This aminotransferase of 29 IU/L, alkaline phosphatase of 63,
case report exemplifies the importance of early diagnosis total bilirubin of 0.8, prothrombin time of 13.6 s, partial
and treatment of ruptured HCC. thromboplastin time of 25.7 s, international normalized ratio
of 1.3, albumin of 3.9 g/dL, alpha-fetoprotein (AFP) of 1380
CASE REPORT
ng/mL, and hepatitis C antibodies were positive, but with an
undetectable viral load, hepatitis B antibodies and surface
We are reporting a case of a 64-year-old female with past antigen were negative.
medical history of hypertension and hepatitis C, who was
diagnosed and treated in the year 2000 with interferon An abdominal ultrasound showed a 7 cm × 6 cm mass in the
and ribavirin. She presented to our emergency department
right hepatic lobe, abdominal computed tomography (CT)
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DOI: How to cite this article: Hawatmeh A, Jumean K, Arqoub AA, Shaaban
10.4103/2394-5079.171207 H. Spontaneous rupture of hepatocellular carcinoma. Hepatoma Res
2016;2:103-6.

103 © 2016 Hepatoma Research | Published by OAE Publishing Inc.