Abstract
A 77-year-old man who had undergone transcatheter arterial chemoembolization (TACE) following a diagnosis of type C hepatitis, liver cirrhosis, and multiple lesions of hepatocellular carcinoma complained of upper abdominal pain 7 months after the TACE procedure and was immediately hospitalized. He was found to be in shock with significant anemia, and, based on abdominal CT and aspiration of ascites, he was diagnosed as having hepatic rupture from a hepatocellular carcinoma. Emergency angiography showed tumor stain and blood vessel leakage in the lateral segment, and selective transcatheter arterial embolization (TAE) was performed to achieve hemostasis. The patient's subsequent course was good, and he was discharged from hospital. However, three months after TAE, he again suffered intense abdominal pain. As on the previous admission, the patient was in shock and anemic, and intraperitoneal bleeding from another rupture of the hepatocellular carcinoma was suspected. Emergency angiography revealed tumor stain in the tumor in S6 of the liver, which was thought to be responsible for the bleeding. Selective TAE was conducted to achieve hemostasis. This patient's two hemorrhagic episode were due to rupture of separate hepatic tumors. However, in both cases, diagnosis based on emergency abdominal angiography and hemostasis with TAE as a rapid response was very effective, and the patient could be rescued.
