Curative treatment for recurrent tumour implantation after ruptured hepatocellular carcinoma

Spontaneous rupture of hepatocellular carcinoma with intraperitoneal haemorrhage is a life-threatening condition. Intraperitoneal spread of the tumour after rupture occurs uncommonly. We report two cases of curative management for recurrent tumour implantation after ruptured hepatocellular carcinoma. The two patients presented with ruptured hepatocellular carcinoma and were treated with transarterial embolisation in the acute episode. Interval partial hepatectomy of the carcinoma was performed after the acute episodes. The first patient presented with a large epigastric mass 2 years after rupture. The mass was found to be adherent to the stomach and omentum. Distal gastrectomy was performed. The second patient presented with a right upper quadrant mass 4 months after rupture, and had a huge tumour attached to the ascending colon. Right hemicolectomy and omentectomy were performed. On histological examination, both tumours were confirmed to be recurrent hepatocellular carcinomas with clear surgical margins. After resection, both patients had no tumour recurrence at 1 year and 3 years, respectively.