Abstract
A 74-year-old man was admitted to the emergency department due to sudden right lateral abdominal pain. On computed tomography (CT), rupture of a hepatocellular carcinoma (HCC) in segment 7 of the liver was observed, and transcatheter arterial chemoembolization (TACE) was subsequently performed because of hemorrhagic shock. The patient recovered from his initial critical condition. Three days later, the patient developed respiratory failure due to acute interstitial pneumonia, but he recovered with artificial respiration and steroid pulse therapy. Twenty days later, the patient developed biliary peritonitis due to necrosis and perforation of the gallbladder, but he again recovered with drainage. A second TACE was performed four months later followed by a third eight months later. Eleven months later,intrahepatic metastasis and peritoneal dissemination were not detected, and right hepatectomy with removal of part of the diaphragma and cholecystectomy was performed. On pathology, a diagnosis of a moderately to poorly differentiated hepatocellular carcinoma was made. The patient was discharged on postoperative day 18 and remains alive 2 years 9 months after surgery without recurrence. Transcatheter arterial embolization (TAE) for initial hemostasis followed by secondary hepatectomy might improve the prognosis of patients with HCC who develop hemorrhagic shock.
