A Case of Spontaneous Rupture of Hepatocellular Carcinoma of the Left Caudate Lobe (Spiegel's Lobe) with Stalk

Yasunari Kawabata¹⁾²⁾, Seiji Yano²⁾, Chosei Kusumoto¹⁾, Katsuhumi Miyamoto¹⁾, Touko Inao²⁾, Takeshi Nishi²⁾, Noriyuki Hirahara²⁾, Masayuki Itakura²⁾ and Tsuneo Tanaka²⁾

Department of Surgery, Harima Hospital of Ishikawajima-Harima Heavy Industries, Health Insuarance Society¹⁾
Department of Digestive and General Surgery, Shimane University Graduate School of Medicine²⁾

A 67-year-old man admitted for sudden severe upper abdominal pain was found in abdominal computed tomography to have ruptured hepatocellular carcinoma (HCC) in the left caudate (Spiegel) lobe protruding caudally with hematoma into the lesser omentum. After hemostasis, stabilization of his general condition, and liver function evaluation, we conducted T2-weighted imaging that showed a low-intensity mass occupying the entire Spiegel lobe and involving the proper hepatic artery and portal vein. We conducted partial hepatectomy after his general condition improved. Macroscopically, the tumor was attached by a stalk to the surface of the Spiegel lobe. Histological examination showed moderately differenciated hepatocellular carcinoma and hemorrhagic change in the stalk. The postoperative course was uneventful. Twelve case reports of HCC rupture of HCC of the caudate lobe have been made, to the best of our knowledge, and a case of spontaneous HCC rupture of the Spiegel's lobe with a stalk is very rare.

Key words
hepatocellular carcinoma, spiegel's lobe, rupture

Reprint requests
Yasunari Kawabata Department of Digestive and General Surgery, Shimane University Graduate School of Medicine
89-1 Enya-cho, Izumo, 693-8501 JAPAN

Accepted
February 28, 2007

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