ABSTRACT
Hepatocellular carcinoma (HCC) has a tendency of rupturing, which can lead to massive hemorrhage. Although the majority of HCC ruptures occur in the liver, some reports have shown that HCC ruptures developed at various metastatic sites including the lung, pleura, rib, sternum, spleen, kidney, adrenal gland, mediastinal lymph node, peritoneum, ileum, and peripancreatic lymph node. Here, we reported a case of HBV-related HCC rupture that was treated by operation and recurred in the form of ruptured omental metastasis. A 55- year-old man, who complained of diffuse abdominal pain, was admitted to our hospital in a state of shock. Abdominal CT showed massive hemoperitoneum with a HCC of 6 cm size in diameter in the left lobe of the liver. The alphafetoprotein level was above 300 ng/ml. After transarterial chemoembolization for hemostasis, left lateral segmentectomy was performed. Resected tumor showed complete tumor necrosis. Four months later, the follow-up CT revealed an extrahepatic abdominal tumor near the transverse colon. With surgery, a ruptured tumor implanted on the great omentum near the transverse colon was found and removed along with the segmental transverse colon. The pathologic result reported that the omental tumor was a poorly differentiated hepatocellular carcinoma.