[Ruptured hepatocarcinoma. Report of 20 cases and review of the literature].

Hepatocellular carcinomas may rupture in rare cases (5 to 15%) creating a serious short-term and mid-term situation. Over a period of 10 years, 20 patients (19 males, 1 female, mean age 68 years, range 38-82) were treated for ruptured hepatocellular carcinoma involving a cirrhotic (ethylic) liver in 12 cases, haemochromatosis in 2 and a normal liver in 6. Twelve patients underwent emergency surgery for acute haemoperitonium operation was delayed until after exploratory investigations (CT scan and arteriography +/- embolization) for pain in the right hypochondria associated with partitioned effusion and anaemia. The diagnosis of cancer had been known in 5 patients and rupture was the first manifestation in 15 others. Emergency procedures, 7 excisions, 3 sutures, were performed but 2 patients died during vascular clamping. Four deaths occurred within 8 days due to liver failure. There were no postoperative deaths after programmed procedures, 6 excisions, 1 ligature. One patient underwent embolization peroperatively and died 6 days later due to digestive haemorrhage and liver failure. Lesions were localized in the left liver (9), right liver (6) and in both with multiple nodules (5). Among the 13 survivors, 7 died within a delay of 2 to 30 months, 1 due to recurrent rupture (5%). Six patients are still living with a follow-up of 3 to 36 months (including 2 hepatocellular carcinomas on a healthy liver and 1 with haemochromatosis). A review of the literature confirms the severity of such events whatever the initial management. Acute rupture of hepatocellular carcinoma usually requires emergency procedures with a high risk of mortality (50%). Fissuration authorizes explorations and possibly peroperative embolization with better immediate results.