Non-bleeding Spontaneous Rupture of Hepatocellular Carcinoma
A 62-year-old non-diabetic, non-alcoholic male patient attended to our out-patient department with the complaint of dull aching pain in the right upper part of the abdomen. He was suffering from such pain since last 1 month. Pain responded to analgesic. He lost around 3 kg weight in last 1 month. He lost appetite also.\nAbdominal ultrasonography was performed, which suggested HCC with ascites. Triple phase contrast enhanced computer tomography (CECT scan) revealed HCC of 12 cm × 15 cm size in segments 6 and 7 of liver []. Computer tomography also showed typical radiological characteristics of HCC (arterial enhancement of liver mass and wash out on delayed phase, arterioportal shunt [Figures –], portal vein thrombosis). There was gross ascites. No extravasation of dye seen. Ruptured tumor through liver capsule [] was seen with necrosis and hemorrhage in the center of the tumor.\nPatient was admitted for evaluation. His blood pressure and heart rate was normal. Peritoneal tapping was performed for ascetic fluid analysis. Ascetic fluid was clear, exudative in nature with serum to ascetic fluid albumin gradient less than 1.1. Cytological examination ascetic fluid revealed no tumor cell.\nOn evaluation for chronic liver disease, all viral markers were negative. Upper gastrointestinal endoscopy showed non-bleeding grade II esophageal varices. On biochemical analysis of blood total and direct bilirubins were 1.98 and 0.48 respectively. Liver enzymes were raised (Aspartate transaminase-51 IU/ml and alanine amino transferase -55 IU/ml) with normal total protein and albumin. His hemoglobin was 12.4 g% and cell counts were normal. Alpha fetoprotein was high (424 ng/ml; normal range 0-8.5) and carcinoembryonic antigen was normal.\nThe disease was in advanced staged to be cured by surgery and portal vein thrombosis excluded TACE from treatment options; therefore, transarterial radioembolization was offered, but patient refused it.