Hepatic resection in cirrhotic patients.

Cirrhotic patients are at increased risk for the development of hepatocellular carcinoma, and surgical resection of the involved liver represents the only effective mode of therapy. The presence of cirrhosis significantly complicates hepatic resection. We describe the clinical course of a patient with ruptured hepatoma localized to the lateral segment of the left lobe. This case illustrates many of the problems encountered during hepatic resections in cirrhotic patients, which should be limited to segmental or subsegmental resections. Preoperative attention to bleeding and nutrition, meticulous intraoperative hemostasis, and postoperative management of any pulmonary complications, ascites, and renal or hepatic failure are mandatory for successful management.

Spontaneous rupture of hepatocellular carcinoma.

Spontaneous rupture of a primary hepatocellular carcinoma is an extremely rare event in the western hemisphere. Only a handful of single-case reports have been authored in the continental United States. A ruptured hepatoma carries a dismal prognosis and is usually beyond a "resection for cure" stage. In this report, two cases of spontaneously ruptured primary hepatocellular carcinoma are described. Both cases involved cirrhotic livers, and the tumor in each case was resected to attempt cure. One patient survived nearly 2 years; the other is alive and well at this time.

Pathological rupture of the spleen associated with hepatitis A.

Spontaneous rupture of the spleen refers to rupture of a normal spleen in the absence of trauma. Atraumatic rupture of a diseased spleen is termed pathological rupture and has been described in a variety of pathological conditions. This report describes a case of pathological splenic rupture associated with hepatitis A confirmed by positive IgM antibodies. To the best of our knowledge, this case represents the sole verified example of this previously unrecognized life-threatening complication of hepatitis.

Cholecystectomy in cirrhotic patients.

Cholecystectomy is the most common intraperitoneal operation done by general surgeons in this country and is generally considered safe. The incidence of cholelithiasis is doubled among cirrhotic patients, and biliary surgery in such patients carries tremendous risk, primarily due to excessive intraoperative hemorrhage. One author has reported a mortality of 83% among patients with severe cirrhosis having cholecystectomy. In this report, we review seven consecutive cirrhotic subjects having biliary surgery. There were no deaths. Blood loss roughly correlated with preoperative prothrombin times. Blood transfusions were required in five patients. Factors believed to improve operative outcome are discussed.

Coexisting carcinoid tumor and Crohn's disease.

Several malignancies have been described occurring simultaneously with regional enteritis. Only four examples of coexistent carcinoid and Crohn's disease have been described worldwide. In this report, two new cases of simultaneous Crohn's disease and carcinoid tumor, diagnosed and treated within a single month, are presented. In one instance, a segment of terminal ileum contained regional enteritis, carcinoid tumor, and a small focus of adenocarcinoma.