Lugito Nata P Hardjo, Kurniawan Andree, Yaruntradhani Rizki, Rachman Andhika
Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Acta Med Indones. 2015 Jan;47(1):56-60.
We are reporting a male, 46 years old came to emergency unit with a chief complaint of abdominal tenderness since 1 day prior to admission. No history of abdominal trauma. He often felt abdominal discomfort for the last 5 years. Physical examination revealed decreased consciousness, shock, pale conjungtiva, distended abdomen, with tenderness of the whole abdomen on palpation, and no bowel movement. Laboratory examination found anemia, leucocytosis, normal amilase and lipase. FAST (focus assissted Sonography on trauma) found massive ascites. Patient underwent cito laparotomic exploration that found blood on abdominal cavity, nodular liver, and actively bleeding tumour of liver. During hospitalization, patient recovered and discharged. In the case of acute abdomen, spontaneous ruptured hepatocellular carcinoma (HCC) is one of differential diagnosis, considering high incidence of HCC in South East Asia, especially Indonesia. Confirming diagnosis of generalized peritonitis requires abdominal CT scan and ultrasonography, to rule out ruptured HCC.
我们报告一名46岁男性，因入院前1天出现腹部压痛为主诉前来急诊室。无腹部外伤史。在过去5年里他经常感到腹部不适。体格检查发现意识减退、休克、结膜苍白、腹部膨隆，触诊全腹压痛，无排便。实验室检查发现贫血、白细胞增多，淀粉酶和脂肪酶正常。FAST（创伤重点超声检查）发现大量腹水。患者接受了紧急剖腹探查，发现腹腔内有血液、肝脏结节以及肝脏活动性出血肿瘤。住院期间，患者康复出院。在急腹症的情况下，考虑到东南亚尤其是印度尼西亚肝癌的高发病率，自发性破裂肝细胞癌（HCC）是鉴别诊断之一。确诊全身性腹膜炎需要进行腹部CT扫描和超声检查，以排除破裂的肝癌。
