Mehmet AZİRET, Metin ERCAN, Kerem KARAMAN, Necattin FIRAT, Erdal Birol BOSTANCI, Musa AKOĞLU

Sıradışı Bir Hemorajik Şok Nedeni Spontan Hepatosellüler Karsinom Rüptürü: Olgu Sunumu

Giriş: Spontan Hepatosellüler Karsinom (HSK) rüptürü nadir görülen mortalitesi yüksek bir komplikasyondur ve genellikle kronik karaciğer yetmezliğinin ileri evrelerinde ortaya çıkmaktadır.Olgu Sunumu: 66 yaşında erkek hasta spontan HSK rüptürü nedeniyle acil serviste değerlendirildi. Hastanın hemoglobin 5 gr/dl ve hematokriti % 19 idi ve hastada solukluk, şuur kaybı, batında distansiyon ve taşikardi mevcuttu. Abdominal kontrastlı bilgisayarlı tomografi (BT)’ de perihepatik alanda yaygın hematom ve karaciğer kubbede segment 5’ den 8’ e uzanan 37.7 x 35 mm ebatlarında laserasyon hattı tespit edildi. Hasta hemorajik şok tablosunda idi ve exploratif laparotomi yapıldı. Tümör negatif cerrahi sınırlar ile rezeke edildi. Hastanın postoperatif takiplerinde sıkıntı olmadı ve taburcu edildi.Tartışma: HSK rüptürü, koagülopati, hemodinamik instabilite, karaciğer yetersizliği ve hemorojik şok gibi fatal komplikasyonlar ile karakterize katastrofik bir durumdur. Tanı ve tedavisinin erken yapılması hayatta kalımla yakın ilişkilidir. Tanıda genellikle kronik hepatitli hastalarda ani gelişen karın ağrısı, karında şişlik, solukluk, hipotansiyon ve taşikardi gibi hemorajik şok bulguları mevcuttur. Hematokritte ani düşüş tanı koydurucu olabilmektedir. Ultrasongrafi ve BT rüptüre karaciğer kitlesi, intraperitoneal sıvı veya hematomu göstermede faydalıdır. Rüptürü HSK’ nun rezeksiyonu mümkünse önerilen tedavi yöntemidir. Seçilmiş ve cerrahi yapılamayacak hastalarda transarteriyel kemoterapi (TAKE) yöntemi alternatif yöntemdir. Sonuç: Spontan HCC rupture hayatı tehtid eden ciddi bir durumdur. Acil durumlarda rüptüre tümörün rezeksiyonu hem hayat kurtarıcı hem de primer hastalığın tedavi seçeneğidir.

Anahtar Kelimeler:

Hemorajik şok; Hepatosellüler Karsinom (HCC); HCC rüptürü; Cerrahi tedavi

An Unusual Hemorrhagic Shock Caused by Spontaneous Rupture of Hepatocellular Carcinoma: A Case Report

Introduction: Spontaneous rupture of hepatocellular carcinoma (HCC) is a rare but fatal complication that can be occurred during follow up in advanced stages of chronic liver failure.Case Report: A 66-year-old male was admitted with tachycardia, fade and abdominal distention to the emergency clinic. The patient’s hemoglobin level was 5 mg/dl and the hematocrit value was 19 %.Abdominal contrast-enhanced computed tomography (CT) detected an extensive hematoma in the perihepatic area with a laceration of 37.7x35 mm in the dome of the liver extending from segment V to segment VIII. An emergent explorative laparotomy was performed in hemorrhagic shock status. The tumor mass was resected with negative surgical margins. Patient’s postoperative course was uneventful.Discussion: Spontaneous HCC rupture is a catastrophic situation which generally occurs suddenly and leads to coagulopathy, hemodynamic instability and liver failure. These patients have usually sudden abdominal pain, dizziness, confusion, fainting, tachycardia, and are often referred to emergency clinic with hemodynamic instability or in hemorrhagic shock status. Fall in hemotocrit levels is remarkable. Ultrasonography (USG) and CT is useful in detecting the ruptured liver mass, intraperitoneal fluid or hematoma. Resection of the ruptured tumor -if possible- should be considered. Transarterial chemoembolization (TACE) and Transarterial chemoembolization (TACE) are another alternative treatment options in selected cases where surgery is not suitable. Conclusion: Spontaneous HCC rupture is a serious life-threatening complication. If possible, resection of the ruptured tumor mass in emergency situations is not only lifesaving but also the treatment of choice of the primary disease.

Keywords:

Hemorrhagic shock; hepatocellular carcinoma (HCC); Spontaneous HCC rupture; Surgical resection,

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