A hematoma confined to the center of the abdomen

Spontaneous rupture of a hepatocellular carcinoma is a rare and lethal complication in the emergency department. A cau-date lobe hepatoma rupture is even rarer. It can be treated with vascular embolization, surgical intervention or supportive care. A 70-year-old woman with underlying hepatocellular carcinoma presented to our emergency department with severe abdominal pain encompassing the entire region for half a day. Abdominal computer tomography scans with and without contrast medium revealed a large hematoma confined to the lesser sac of the abdomen. It was initially diagnosed as a ruptured aneurysm. A ruptured caudate lobe hepatoma with acute hemorrhage into the lesser sac was diagnosed after reviewing and discussing the imaging findings with the radiologist. The patient was treated with supportive care without vascular embolization or surgical intervention because there was no imaging evidence of active contrast extravasation and the vital signs were within the normal range. After reviewing the literature, our case appears to be the second only case treated with supportive care and discharged without complications.

hepatoma, hepatocellular carcinoma, caudate, rupture, peri-tonitis

1. Takahashi A, Saito H, Takahashi Y, Sato A, Takagi T, Irisawa A, et al. Cyst-like extension of hepatic subcapsular bleeding caused by rup-tured hepatocellular carcinoma into the bursa omentalis. Hepatol Res 2009;39:1010-4.

2. Lin CH, Hsieh HF, Chou SJ, Yu JC, Chen TW, Hsieh CB. Ruptured caudate lobe hepatocellular carcinoma presents with lesser sac tumor. Rev Esp Enferm Dig 2006;98:703-4.

3. Iwasaki Y, Tani I, Nakajima Y, Ishikawa T, Umeda S, Kusano S. Lesser sac hematoma as a sign of rupture of hepatocellular carcinoma in the caudate lobe. Eur Radiol 2001;11:422-6.

4. Nakao A, Matsuda T, Koguchi K, Funabiki S, Mori T, Kobashi K, et al. Spontaneous rupture of hepatocellular carcinoma of the caudate lobe. Anticancer Res 2000;20:2223-7.