Percutaneous transhepatic intra-arterial ethanol injection therapy for ruptured hepatocellular carcinoma

Spontaneous tumor rupture is a serious complication of hepatocellular carcinoma. In order to avoid such a situation and to recover serious condition, it is very important whether hemostasis can be achieved by stopping tumor bleeding.Recent reports revealed that transarterial embolization, we can successfully stop bleeding with high probability, but there are difficult cases to embolize due to anatomical problems. Here, we report a case of percutaneous transhepatic intra-arterial ethanol injection therapy for ruptured hepatocellular carcinoma. In this case, tumor feeding artery diverged from the cystic artery, so we could not performed selective catheter cannulation into the tumor feeding artery. So we attempted arterial puncture under color doppler echo, the artery was identified by ultrasonography using sonazoid. After arterial puncture, we injected ethanol in to the tumor feeding artery until the color doppler signal disappeared, and then we performed dynamic computed tomography. Computed tomography revealed that the tumor stain had disappeared completely. At present this method is not a general treatment, because this approach may lead to serious complications, such as bleeding from the hepatic artery.In this case report, we think that to establish a treatment method, it is very important to accumulate the resemble cases. And when this treatment is performed, good understanding of not only the overall clinical status but also the hemodynamic profile of the patient is essential.