Spontaneous rupture of primary hepatoma: report of 63 cases with particular reference to the pathogenesis and rationale treatment by hepatic artery ligation.

Of 508 cases of primary liver cancer admitted during 1970-1978, 63 cases had spontaneous rupture of carcinomatous nodules. The association with cirrhosis among noncomplicated cases was 65% and 93% in cases with the rupture (P less than 0.001). In most instances, the presenting symptoms were not dramatic and could be indistinguishable from other uncomplicated carcinoma of the liver. Sixteen patients were treated conservatively and all died. The other ten patients who presumably bled due to coagulation defect were also given conservative treatment and the mortality rate was only 60%. Hepatic artery ligation was employed in 26 cases with 54% mortality but bleeding stopped in 92%, as compared with other conventional surgical measures such as packing, suture, and cauterization to control hemorrhage with 90% mortality rate. There is ample evidence that hepatic venous obstruction due to the tumor invasion and portal hypertension due to the pre-existing cirrhosis play important roles in the pathogenesis of spontaneous rupture of the tumor. Hepatic artery ligation is a rationale treatment because it not only cuts off blood supply to the tumor nodule which is almost exclusively nourished by arterial blood, but also reduces the degree of portal hypertension in cirrhosis.

Intraperitoneal hemorrhage due to spontaneous rupture of primary liver cancer with particular reference to hepatic artery ligation.

During 1970-1976, 459 cases of primary carcinoma of the liver were admitted to the Department of Medicine, Siriraj Hospital, Thailand. Three hundred and two cases (66%) had associated cirrhosis. Fifty-five cases or 12 per cent presented with hemoperitoneum from ruptured carcinomatous nodules. In most of these, the presenting symptom were not dramatic and might be indistinguishable from other uncomplicated carcinoma of the liver. Only 2 cases presented as acute abdomen and 5 cases had severe abdominal pain for short duration prior to admission. Peritonoscopy were performed routinely in all cases with hemoperitoneum except the two cases which presented as acute abdomen. Fifty cases or 91 per cent had associated cirrhosis and the site of the rupture were visualized in 6 cases or 11.32 per cent. Fourteen patients were treated conservatively with the mortality rate of 100 per cent. Eight patients who presumably bled from coagulation defect were also treated conservatively with only 50 per cent mortality. Hepatic artery ligation was employed in 23 cases with 52 per cent mortality and bleeding stopped in 95 per cent, as compare with other conventional surgical measure such as packing, suture and cauterization to control the hemorrhage with 90 per cent mortality. Judging from our experience, hepatic artery ligation is of definite value for palliative treatment particularly in patient with hemoperitoneum from ruptured carcinoma of the liver.