[The intraperitoneal bleeding of hepatocellular carcinoma].

Intraperitoneal bleeding due to spontaneous rupture of hepatocellular carcinoma (HCC) is often a life-threatening condition as well as a poor prognostic sign in terms of the spread of neoplastic disease. Up to 12% of the patients with HCC are reported to develop this complication in Asia, while few cases have been observed to date in western countries, even in areas such as Italy where incidence of hepatocellular carcinoma is high. There is a lack of specific symptoms, therefore a correct diagnosis can be made only if the possibility of hepatocellular carcinoma rupture is taken into account in case of spontaneous hemoperitoneum and if imaging procedures are carefully focused on the liver. Once the presence of the malignant liver neoplasm is demonstrated, non surgical management, aimed solely at controlling the hemorrhage, can be considered. Herein we report 8 cases of spontaneous intraperitoneal bleeding observed in our Department. Our experience confirms that an exact diagnosis is rarely made before laparotomy and that long-term prognosis is poor even after surgical resection of the tumor: 5 of 7 patients who had hepatic resection developed an early recurrence and 4 of them died within one year.