Spontaneous Rupture of Hepatocellular Carcinoma in a Young Patient with Fatal Outcome

Gastrointestinal Bezoars in Paediatrics: Case Series and Literature Review

BACKGROUND

Bezoars are indigestible lumps which are usually found in stomach. Types of bezoar include phytobezoar, trichobezoar, lithobezoar, pharmacobezoar, plasticobezoar, lactobezoar and metal bezoar. Trichobezoars mostly affect females in 20s and 30s with a rarity in paediatrics. Unexplained complaints with a palpable mass are commonly found in these patients. Treatment involves retrieval of mass with searching for others. The purpose of this study was to present data and surgical management of cases with trichobezoars.

MATERIALS AND METHODS

We documented a retrospective review of trichobezoars done in our hospital between 2016 and 2022. All demographic data collected included gender and age of cases, composition and extent of bezoar, clinical presentation, imaging modalities, endoscopic trial, surgical approach and outcome.

RESULTS

Five cases of gastrointestinal tract (GIT) trichobezoars underwent surgery. All cases were females between (13 and 16 years). Trichobezoars were three gastric, one ileal and one of combined gastric and colonic. Complaints were abdominal pain, vomiting, weight loss and halitosis. Three cases had a palpable abdominal mass. Different radiological modalities were performed. Endoscopic retrieval was tried in one patient and the laparoscopic approach in another one, but the first route failed. Laparotomy followed by gastrotomy, enterotomy and colotomy was done without complications.

CONCLUSIONS

Trichobezoars should be suspected in any child with unexplained abdominal complaints or with a palpable abdominal mass, especially in girls. Imaging can be done in different modalities for diagnosis. Endoscopic retrieval could be tried; however, its failure is common, necessitating laparotomy, which has an excellent outcome.

Imaging findings of spontaneous intraabdominal hemorrhage: neoplastic and non-neoplastic causes

Contrary to traumatic and iatrogenic intraabdominal hemorrhages, spontaneous intraabdominal hemorrhage is a challenging clinical situation. A variety of neoplastic and non-neoplastic conditions may cause spontaneous intraabdominal bleeding. Imaging findings vary depending on the source of bleeding and the underlying cause. In this article, we aim to increase the awareness of imagers to the most common causes of spontaneous intraabdominal hemorrhage by using representative cases.

Acute hemoperitoneum after ruptured hepatocellular carcinoma: First Moroccan SCARE-compliant case report and literature review

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Acute hemoperitoneum after a spontaneously ruptured hepatocellular carcinoma (HCC) is a rare complication.

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In cases with stable conditions, imaging guided by computed tomography (CT) enables arterial embolisation.

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Surgery is a choice after failure of embolisation or in case of severe hemodynamic instability.

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The prognostic outcomes of ruptured HCC depend mostly on the underlying liver function.

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Successful management by one-stage surgery allowed radical treatment of this rare entity.

Introduction

Acute hemoperitoneum with a spontaneously ruptured hepatocellular carcinoma (HCC) is a rare type of internal bleeding that requires a multidisciplinary management approach.

Presentation of case

In this case report, we describe a fortuitously ruptured peripheral and discovered HCC in an 81-years-old woman treated effectively using hepatectomy.

Discussion

The use of the computed tomography (CT) angiography to diagnose the stability of the patient’s condition allows both arterial embolization in case of active bleeding and the evaluation of the underlying hepatopathy. The place of surgery is particularly upon after both the failure of arterial embolization and while facing a severe hemodynamic instability. The surgical strategy varies between perihepatic tamponnade and a surgical resection in one or more stages. The prognosis of a ruptured HCC depends mainly on the underlying liver’s function.

Conclusion

Multidisciplinary management of spontaneously ruptured HCC results in the same survival outcome as non-ruptured HCC at the same stage of hepatopathy.

Massive hemoperitoneum and upper gastrointestinal hemorrhage following liver rupture secondary to gallbladder perforation: A case report and literature review

RATIONALE

Available literature states that the common reasons for non-traumatic spontaneous liver rupture are hepatocellular carcinoma, macronodular cirrhosis, hemangioma, and other tumors; gallbladder perforation is not cited as a cause.

PATIENT CONCERNS

The patient presented with sudden-onset right upper quadrant pain with tarry stool for 3 days after eating with dysphoria and increasing thirst; gradually, hemorrhagic shock developed. He had no history of trauma, no background of chronic hepatitis, and no cirrhosis.

DIAGNOSIS

Hemorrhage secondary to spontaneous rupture of intrahepatic cholangiocarcinoma.

INTERVENTIONS

Left hemihepatectomy, cholecystectomy, and common bile duct exploration were performed.

OUTCOMES

The patient was diagnosed with massive hemoperitoneum accompanying upper gastrointestinal hemorrhage following liver rupture secondary to gallbladder perforation. The postoperative course was uneventful and the patient was discharged after 10 days of hospitalization.

LESSONS

If patients present with non-traumatic spontaneous liver rapture accompanying cholelithiasis and gallbladder hematoma, gallbladder perforation should be considered as a differential diagnosis. Misdiagnosis can lead to incorrect treatment.