[Two cases of asymptomatic ruptured hepatocellular carcinoma]

We describe 2 cases of asymptomatic ruptured hepatocellular carcinoma diagnosed for the first time after the start of the operation. The first case is a 62-year-old woman. A tumor with a diameter of 3.6 cm was observed in the liver lateral segment on the abdominal computed tomography(CT) scan. She had not reported any subjective symptoms. Although we started operation using the laparoscope, we recognized a tumor burst and continuous bleeding. Bleeding was reduced by detaching the left hepatic artery from the left gastric artery, and left lateral hepatectomy was completed using the laparoscope. The second case is an 82-year-old man. A tumor with a diameter of 13 cm was observed in the left liver on the abdominal CT scan. He had also not reported any subjective symptoms. At the start of the operation, we observed about 200 mL of blood and a hematoma in the circumference of the liver. We intercepted the left Glisson's pedicle promptly and performed a left hepatectomy. Although it was unclear when these tumors were ruptured in both cases, they were bleeding from the burst part continuously at the time of the operation. The tumors were safely excised by controlling blood inflow as much as possible in the early stages of the operation.