Emergency open drainage of massive hemoperitoneum and early stage left hepatectomy for abdominal compartment syndrome due to hepatocellular carcinoma rupture: a case report
Abstract Background Spontaneous rupture is one of the most life-threatening complications of hepatocellular carcinoma (HCC). Transcatheter arterial embolization (TAE) effectively achieves hemostasis in patients with hemodynamic instability. However, there have been no reports of abdominal compartmen...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-06-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-022-01478-7 |
| _version_ | 1818219042321727488 |
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| author | Makoto Kurimoto Kenya Yamanaka Masaaki Hirata Makoto Umeda Tokuyuki Yamashita Hikaru Aoki Yusuke Hanabata Akina Shinkura Jun Tamura |
| author_facet | Makoto Kurimoto Kenya Yamanaka Masaaki Hirata Makoto Umeda Tokuyuki Yamashita Hikaru Aoki Yusuke Hanabata Akina Shinkura Jun Tamura |
| author_sort | Makoto Kurimoto |
| collection | DOAJ |
| description | Abstract Background Spontaneous rupture is one of the most life-threatening complications of hepatocellular carcinoma (HCC). Transcatheter arterial embolization (TAE) effectively achieves hemostasis in patients with hemodynamic instability. However, there have been no reports of abdominal compartment syndrome (ACS) caused by massive intra-abdominal hematoma after TAE. We report emergency open drainage of a massive hematoma for abdominal decompression and early stage left hepatectomy at the same time. Case presentation A 75-year-old woman was transported to our emergency department with hypovolemic shock. Dynamic contrast-enhanced computed tomography revealed extravasation of contrast medium from a HCC lesion in the medial segment of the liver and a large amount of high-density ascites. TAE was immediately performed to achieve hemostasis. Three hours after the first TAE, we decided to perform a second TAE for recurrent bleeding. After the second TAE, the patient’s intra-abdominal pressure increased to 35 mmHg, her blood pressure gradually decreased, and she had anuria. Thus, she was diagnosed with ACS due to spontaneous HCC rupture. Twenty-seven hours after her arrival to the hospital, we decided to perform open drainage of the massive hematoma and left hepatectomy for ACS relief, prevention of re-bleeding, tumor resection, and intraperitoneal lavage. The operative duration was 225 min, and the blood loss volume was 4626 g. Postoperative complications included pleural effusion and grade B liver failure. She was discharged on postoperative day 33. The patient survived for more than 3 years without functional deterioration. Conclusions Even after hemostasis is achieved by TAE for hemorrhagic shock due to spontaneous rupture of HCC, massive hemoperitoneum may lead to ACS, particularly in cases of re-bleeding. Considering the subsequent possibility of ACS and the recurrence of bleeding, early stage hepatectomy and removal of intra-abdominal hematoma after hemodynamic stabilization could be a treatment option for HCC rupture. |
| first_indexed | 2024-12-12T07:33:22Z |
| format | Article |
| id | doaj.art-b78d01646bde43fd9e64a1e9843ac396 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-12-12T07:33:22Z |
| publishDate | 2022-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-b78d01646bde43fd9e64a1e9843ac3962022-12-22T00:32:58ZengSpringerOpenSurgical Case Reports2198-77932022-06-01811610.1186/s40792-022-01478-7Emergency open drainage of massive hemoperitoneum and early stage left hepatectomy for abdominal compartment syndrome due to hepatocellular carcinoma rupture: a case reportMakoto Kurimoto0Kenya Yamanaka1Masaaki Hirata2Makoto Umeda3Tokuyuki Yamashita4Hikaru Aoki5Yusuke Hanabata6Akina Shinkura7Jun Tamura8Department of Surgery, Hyogo Prefectural Amagasaki General Medical CenterDepartment of Surgery, Hyogo Prefectural Amagasaki General Medical CenterDepartment of Surgery, Hyogo Prefectural Amagasaki General Medical CenterDepartment of Gastroenterology, Hyogo Prefectural Amagasaki General Medical CenterDepartment of Surgery, Hyogo Prefectural Amagasaki General Medical CenterDepartment of Surgery, Hyogo Prefectural Amagasaki General Medical CenterDepartment of Surgery, Hyogo Prefectural Amagasaki General Medical CenterDepartment of Surgery, Hyogo Prefectural Amagasaki General Medical CenterDepartment of Surgery, Hyogo Prefectural Amagasaki General Medical CenterAbstract Background Spontaneous rupture is one of the most life-threatening complications of hepatocellular carcinoma (HCC). Transcatheter arterial embolization (TAE) effectively achieves hemostasis in patients with hemodynamic instability. However, there have been no reports of abdominal compartment syndrome (ACS) caused by massive intra-abdominal hematoma after TAE. We report emergency open drainage of a massive hematoma for abdominal decompression and early stage left hepatectomy at the same time. Case presentation A 75-year-old woman was transported to our emergency department with hypovolemic shock. Dynamic contrast-enhanced computed tomography revealed extravasation of contrast medium from a HCC lesion in the medial segment of the liver and a large amount of high-density ascites. TAE was immediately performed to achieve hemostasis. Three hours after the first TAE, we decided to perform a second TAE for recurrent bleeding. After the second TAE, the patient’s intra-abdominal pressure increased to 35 mmHg, her blood pressure gradually decreased, and she had anuria. Thus, she was diagnosed with ACS due to spontaneous HCC rupture. Twenty-seven hours after her arrival to the hospital, we decided to perform open drainage of the massive hematoma and left hepatectomy for ACS relief, prevention of re-bleeding, tumor resection, and intraperitoneal lavage. The operative duration was 225 min, and the blood loss volume was 4626 g. Postoperative complications included pleural effusion and grade B liver failure. She was discharged on postoperative day 33. The patient survived for more than 3 years without functional deterioration. Conclusions Even after hemostasis is achieved by TAE for hemorrhagic shock due to spontaneous rupture of HCC, massive hemoperitoneum may lead to ACS, particularly in cases of re-bleeding. Considering the subsequent possibility of ACS and the recurrence of bleeding, early stage hepatectomy and removal of intra-abdominal hematoma after hemodynamic stabilization could be a treatment option for HCC rupture.https://doi.org/10.1186/s40792-022-01478-7Spontaneous ruptureHepatocellular carcinomaTranscatheter arterial embolizationAbdominal compartment syndromeStaged hepatectomy |
| spellingShingle | Makoto Kurimoto Kenya Yamanaka Masaaki Hirata Makoto Umeda Tokuyuki Yamashita Hikaru Aoki Yusuke Hanabata Akina Shinkura Jun Tamura Emergency open drainage of massive hemoperitoneum and early stage left hepatectomy for abdominal compartment syndrome due to hepatocellular carcinoma rupture: a case report Surgical Case Reports Spontaneous rupture Hepatocellular carcinoma Transcatheter arterial embolization Abdominal compartment syndrome Staged hepatectomy |
| title | Emergency open drainage of massive hemoperitoneum and early stage left hepatectomy for abdominal compartment syndrome due to hepatocellular carcinoma rupture: a case report |
| title_full | Emergency open drainage of massive hemoperitoneum and early stage left hepatectomy for abdominal compartment syndrome due to hepatocellular carcinoma rupture: a case report |
| title_fullStr | Emergency open drainage of massive hemoperitoneum and early stage left hepatectomy for abdominal compartment syndrome due to hepatocellular carcinoma rupture: a case report |
| title_full_unstemmed | Emergency open drainage of massive hemoperitoneum and early stage left hepatectomy for abdominal compartment syndrome due to hepatocellular carcinoma rupture: a case report |
| title_short | Emergency open drainage of massive hemoperitoneum and early stage left hepatectomy for abdominal compartment syndrome due to hepatocellular carcinoma rupture: a case report |
| title_sort | emergency open drainage of massive hemoperitoneum and early stage left hepatectomy for abdominal compartment syndrome due to hepatocellular carcinoma rupture a case report |
| topic | Spontaneous rupture Hepatocellular carcinoma Transcatheter arterial embolization Abdominal compartment syndrome Staged hepatectomy |
| url | https://doi.org/10.1186/s40792-022-01478-7 |
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