Surgical management of acutely ruptured hepatoblastoma with definitive oncologic resection

Hepatoblastoma is the most common liver tumor in childhood. In a minority of cases, hepatoblastomas can present with tumor rupture and hemorrhage, particularly in the setting of rapid tumor growth or rapid necrosis after the initiation of chemotherapy. While surgical resection is the mainstay of definitive care in treatment of nonruptured lesions, rupture presents unique challenges in terms of emergent interventions as well as definitive oncologic care. Management of a patient with a symptomatic ruptured hepatoblastoma involves either i) emergent control of hemorrhage with embolization (or operative control of bleeding) followed by adjuvant chemotherapy and definitive resection at a later date, or ii) emergent oncologic resection at presentation followed by adjuvant chemotherapy. We report the case of a 19 month old child with recently diagnosed hepatoblastoma who presented with tumor rupture and hemorrhage shortly after the initiation of chemotherapy. She underwent emergency definitive oncologic resection and recovered well to resume and complete chemotherapy.