A Case of Ruptured Hepatoma Associated with Marked A-P Shunting

Yasunobu Mizukami, Takamasa Nagashima, Hiroshi Ikuta, Nobuyuki Iwaya, Hideo Miyake, Yasuke Kita, Kenji Suzuki, Yasushi Ito, Shigeyo Suzuki

Department of Surgery, Enshu General Hospital

The prognosis of ruptured hepatoma is poor, and most patients die within 6 months. We treated a female patient with ruptured hepatoma accompanied by liver cirrhosis. A 33-year-old woman with hepatitis B visited a hospital with a complaint of progressive abdominal distention. She was diagnosed as having ruptured hepatoma accompanied liver cirrhosis, and referred to our hospital. Ultrasonography revealed marked ascites and a protruding tumor in S₆. Bloody fluid was aspirated. Abdominal angiography showed a tumor stain in S₆ and distended coronary vein caused by portal regurgitation due to marked A-P shunting. Abdominal bleeding stopped spontaneously. After her general condition improved, right hepatic posterior segmentectomy was performed. The resected specimen revealed a tumor embolus in the right posterior branch of the portal vein. She had been healthy with out symptoms of recurrence for 4 years since the operation. A staged and resecting operation is recommended for the treatment of ruptured hepatoma after comfirming that the bleeding has stopped spontaneously or is controlled by TAE and evaluating the liver function.

Key words
hepatoma, spontaneous rupture, A-P shunting

Reprint requests
Yasunobu Mizukami Department of Surgery, Enshu General Hospital
6-144 Tokiwa-cho, Hamamatsu, 430 JAPAN

Accepted
January 13, 1993

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