A long-survival case of ruptured hepatocellular carcinoma treated with nonsurgical interventions

A 49-year-old male was admitted to our hospital due to abdominal distension and anemia. Ultrasonography revealed a tumor of 4cm in diameter in the right lobe of the liver. Hemoperitoneum was suggested from sonographic findings as numerous hyperechoic spots in massive ascites and a flap-like structure on the top of the tumor with extrahepatic growth. Urgent angiography demonstrated a hypervascular mass at the anterior-superior segment of the liver, but no extravasation of the contrast medium was observed. Transcatheter artrial embolization therapy (TAE), using lipiodol and gelatin sponge particles, followed for the treatment of hepatocellular carcinoma (HCC). Six months later, the second nodule was found out in the left lobe of the liver, and treated with TAE again. Thereafter, a total of 3 sessions of the chemoembolization therapy and a total of 6 sessions of the percutaneous ethanol injection therapy were performed against repeated recurrences of the HCC. The patient succumbed to hepatic failure caused by intraperitoneal re-bleeding and progression of HCV-related liver cirrhosis about 8 years after the first TAE against the ruptured HCC.