Hepatosellüler karsinomada spontan intraperitoneal hemorajik rüptür: Olgu sunumu

Hepatosellüler karsinomun (HSK) intraperitoneal hemorajik rüptürü, ölümle seyredebilen birkomplikasyondur. Seçilmiş vakalarda ana tedavi seçenekleri cerrahi girişim ve arterielembolizasyondur. Bu yazıda hepatosellüler karsinomun spontan rüptürü sonrası gelişenintraperitoneal kanamalı olgu sunulmuştur. Karın ağrısı ve hemorajik şok tablosunda dış merkezdeacile başvurmuş 70 yaşında bir erkek hastadır. Karaciğerde intraperitoneal hemorajik rüptüre kitlenedeni ile sütür ile hemostaz ve packing ile ilk müdahalesi yapılan hasta daha sonra tarafımızcagenel durumu ve vital bulguları düzeltilerek tekrar operasyona alınmış depacking sonrası karaciğersegment 4b rezeksiyonu ve kolesistektomi operasyonu yapılmıştır. Hastanın postoperatif dönemdepatoloji sonucu iyi differansiye hepatosellüler karsinom olarak gelmiş olup bu olguda olduğu gibiyeterli tıbbi ve teknik ekipman olmadığında ilk cerrahi müdahale (sütürasyon ile hemostaz vepacking) sonrası ileri bir merkezde elektif cerrahi tedavi yaklaşımı da hayat kurtarıcı olabilir.

Spontaneous intraperitoneal hemorrhagic rupture of hepatocellular carcinoma: A case report

İntraperitoneal hemorajic rupture is a complication of hepatocellular carcinoma that can be mortal.Surgical management and arterial embolisation are the main therapy choices in selected cases. Wepresented a case of hepatocellular carcinoma with spontaneous rupture and intra-abdominalhemorrhage. A 70 years old male was admitted to emergency department with abdominal pain andunstable hemodynamy. Patient was taken the operation room due to intra-abdominal bleeding.İntraoperatif diagnosis was rupture haemorrhagic solid liver mass and they performed depackingand hemostasis. Then they decided to transport patient to our hospital (tertiary hospital). Weperform depacking, liver segment resection (4b) and cholecystectomy operation. Thehistopathological examination for the resected specimen yielded the final diagnosis of well- differentiated hepatocellular carcinoma. As in this case if there is not enough medical andtechnical equipment for curative surgery than after the first surgical intervention has been donetransporting the patient to a tertiary hospital for curative surgery can be saving life.

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