Intraperitoneal hemorrhage due to spontaneous rupture of hepatocellular carcinoma: treatment by hepatic artery embolization.

Seventeen patients with intraperitoneal hemorrhage due to spontaneous rupture of hepatocellular carcinoma were treated by emergency transcatheter arterial embolization. Fine-needle aspiration cytology was used to establish the histologic diagnosis in 11 patients with no history of hepatic malignancy. The other six patients had a pathologic confirmation of hepatic malignancy by open biopsy before admission. Pretreatment angiography showed extravasation of contrast material from the hepatic tumor in four patients (24%). In the other 13 patients, only hypervascular tumors were seen. Successful hemostasis was achieved in all patients. Fourteen patients survived after the embolization; the other three died immediately after embolization. Of the 14 patients, 11 died later (survival time ranged from 16 to 386 days). The remaining three patients are still alive at 3, 7, and 15 months, respectively, after the procedure. No serious complications related to embolization were encountered. Most patients had pain and fever. We conclude that emergency arterial embolization is an effective alternative to surgery for hepatic hemostasis in patients with spontaneous rupture of hepatocellular carcinoma.