Intraperitoneal hemorrhage due to spontaneous rupture of primary liver cancer with particular reference to hepatic...

During 1970-1976, 459 cases of primary carcinoma of the liver were admitted to the Department of Medicine, Siriraj Hospital, Thailand. Three hundred and two cases (66%) had associated cirrhosis. Fifty-five cases or 12 per cent presented with hemoperitoneum from ruptured carcinomatous nodules. In most of these, the presenting symptom were not dramatic and might be indistinguishable from other uncomplicated carcinoma of the liver. Only 2 cases presented as acute abdomen and 5 cases had severe abdominal pain for short duration prior to admission. Peritonoscopy were performed routinely in all cases with hemoperitoneum except the two cases which presented as acute abdomen. Fifty cases or 91 per cent had associated cirrhosis and the site of the rupture were visualized in 6 cases or 11.32 per cent. Fourteen patients were treated conservatively with the mortality rate of 100 per cent. Eight patients who presumably bled from coagulation defect were also treated conservatively with only 50 per cent mortality. Hepatic artery ligation was employed in 23 cases with 52 per cent mortality and bleeding stopped in 95 per cent, as compare with other conventional surgical measure such as packing, suture and cauterization to control the hemorrhage with 90 per cent mortality. Judging from our experience, hepatic artery ligation is of definite value for palliative treatment particularly in patient with hemoperitoneum from ruptured carcinoma of the liver.