Hemoperitoneum as a first manifestation of hepatocellular carcinoma in western patients with liver cirrhosis - Effectiveness of emergency treatment with transcatheter arterial embolization

Hemoperitoneum is a well-known form of hepatocellular carcinoma presentatio n and represents a frequent complication in countries with a high incidence of hepatocellular carcinoma, but it is rarely seen in Western countries. O ur aim was to report the results and describe the arteriographic and CT sca n characteristics in a series of seven consecutive patients. They were admi tted to our hospital because of hemoperitoneum due to ruptured tumor as a f irst manifestation of hepatocellular carcinoma, and the rupture was effecti vely controlled by transcatheter arterial embolization. From April 1989 to April 1998, 440 consecutive patients were admitted to our liver unit with t he diagnosis of hepatocellular carcinoma and liver cirrhosis. Fourteen pati ents (3%) presented with acute hemoperitoneum due to tumor rupture as a fir st manifestation of hepatocellular carcinoma. We here report our experience in the group of patients treated by transcatheter arterial embolization. M ean age was 67.1 +/- 5 years (range, 61-73), All patients presented with su dden abdominal pain, abdominal distension, and four patients had symptoms o f acute anemia. In all cases the ruptured tumor was subcapsular. The proced ure was effective in the control of bleeding in all cases, without signific ant impairment in liver function or treatment-related deaths. In six of the seven patients, a self-limited postembolization syndrome was observed. Mea n survival time was 273 +/- 488.7 days (range: 15-1290). Three patients sur vived more than six months but at the time of evaluation, only one patient was alive. In conclusion, the present results confirm that transcatheter ar terial embolization is an effective and well-tolerated treatment in the man agement of hemoperitoneum due to ruptured hepatocellular carcinoma in patie nts with liver cirrhosis.