ABDOMINAL BLEEDING FROM RUPTURED IMPLANTATION FOCI OF HEPATOCELLULAR CARCINOMA IN THE PELVIC SPACE-A CASE REPORT-

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  • KATAGIRI Satoshi
    Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University
  • FUJISAKI Hiroyuki
    Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University
  • HARADA Nobuhiko
    Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University
  • OTSUBO Takehito
    Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University
  • YAMAMOTO Masakazu
    Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University
  • TAKASAKI Ken
    Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University

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  • 骨盤内播種巣からの破裂出血をきたした肝細胞癌の１例

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Abstract

A 65-year-old man who had been followed for hepatocellular carcinoma (HCC) with hepatitis C was brought into the emergency department of our hospital for the sudden onset of lower abdominal pain. There was a previous histry of undergoing a right trisegmentectomy of the liver for HCC 15cm in diameter 4 years before admission. At that time, the hepatic lesion was histopathologically diagnosed as moderately and poorly differentiated HCC with portal vein invasion and intrahepatic metastasis. Thereafter, a caudate lobectomy and three courses of ablation therapy for recurrence of HCC after hepatectomy had been performed. On admission to the hospital, he had severe tenderness and abdominal distention, but no rebound tenderness and muscular defense. On computed tomography, an enhanced tumor 3cm in diameter was identified in the pelvic space with leakage of contrast material. An emergency operation was performed because he went into shock with abdominal bleeding. During the operation, the ruptured tumor infiltrated into a seminal vesicle and a large blood clot were observed in the pelvis. He underwent a removal of the tumor and was discharged 13 days after the operation. Histopathologically, the lesion showed moderately differentiated HCC with trabecular pattern and a hepatocyte stain was positive. In the case of the sudden onset of lower abdominal pain and distention after hepatectomy for HCC, we should suspect the disease which demands proper and speedy diagnosis and medication like in this case.

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