A case of non-occlusive mesenteric ischemia following hepatocellular carcinoma rupture

Hepatocellular carcinoma (HCC) rupture is a severe complication, yet there is limited literature on cases complicated by subsequent non-occlusive mesenteric ischemia (NOMI). A 77-year-old man presented to our hospital with abdominal pain and shock. Arterial phase computed tomography (CT) hepatic arteriography revealed a 77-mm HCC in the left lobe with active extravasation, and the feeding artery was embolized. Although the abdominal pain initially subsided after the procedure, it recurred the next day. A contrast-enhanced CT scan revealed pneumatosis intestinalis and decreased enhancement of the small intestinal wall. The patient underwent resection of the affected segment of the small intestine and was ultimately diagnosed with NOMI based on pathological findings. This is the first reported case of NOMI following HCC rupture. Given the high mortality associated with these conditions, clinicians should be aware of this rare complication and ensure comprehensive evaluation and timely intervention to improve patient outcomes.