An unusual approach to the spontaneous rupture of hepatocellular carcinoma

Our aim is to describe an unusual approach to the spontaneous rupture of a large hepatocellular carcinoma (HCC). A 45-year-old man, Hepatitis C virus (+) (HCV+), complaining of abdominal pain. During the investigation, a tumor affecting liver segments V, VI, VII and VIII, with the presence of fluid within the peritoneal cavity, suggesting hemoperitoneum, was found. The patient was submitted to an exploratory laparotomy, revealing a large hepatic tumor mass with capsule rupture in segment V, biopsy verified the diagnosis of HCC. After one week, a superselective chemoembolization of the nutrient artery of the tumor was performed; one month later, the patient was submitted to an embolization of the right portal branch, aimed at causing hypertrophy of the left lateral portion of the liver. A right hepatectomy was performed, as well as a nodulectomy in segment II, without complications along the 40 days subsequent to the portal embolization. The patient is currently on his 53rd postoperative month and evidences no tumor recurrence to the moment. Although the spontaneous rupture of HCC is uncommon, it can be today treated by combining interventionist radiology procedures and conventional liver resections, offering the patient a better chance of survival.