Intraperitoneal hemorrhage due to spontaneous rupture of primary liver cancer with particular reference to hepatic artery ligation

Abstract

From 1970-76, 459 cases of primary carcinoma of the liver were admitted to the Department of Medicine, Siriraj Hospital, Thailand. Three hundred and two cases (66%) had associated cirrhosis. Fifty-five cases or 12 per cent presented with hemoperitoneum from ruptured carcinomatous nodules. In most of these, the presenting symptoms were not dramatic and might be indistinguishable from other uncomplicated carcinomas of the liver. Only 2 cases presented as acute abdomen and 5 cases had severe abdominal pain for a short duration prior to admission. Peritonoscopy was performed routinely in all cases with hemoperitoneum except the two cases which presented as acute abdomen. Fifty cases or 91 per cent had associated cirrhosis and the site of the rupture was visualized in 6 cases or 11.32 per cent. Fourteen patients were treated conservatively with a mortality rate of 100 per cent. Eight patients who presumably bled from a coagulation defect were also treated conservatively with only 50 per cent mortality. Hepatic artery ligation was employed in 23 cases with 52 per cent mortality and bleeding stopped in 95 per cent, as compared with other conventional surgical measures such as packing, suture and cauterization to control the hemorrhage, with 90 per cent mortality. Judging from our experience, hepatic artery ligation is of definite value for palliative treatment, particularly in patients with hemoperitoneum from a ruptured carcinoma of the liver.