Successful left trisegmentectomy for ruptured hepatoblastoma using intraoperative transarterial embolization

Although surgical treatment with resection for spontaneous rupture of hepatoblastoma into the free abdominal cavity is difficult in small children, it may be the only treatment available. The authors describe a 16-month-old girl who showed a progressive decrease in hematocrit and no response to blood transfusion, after spontaneous rupture of a large hepatoblastoma that extended to the pubic bone. Percutaneous transcatheter arterial embolization could not be performed because selective catheterization was impossible. Therefore, emergency surgery was conducted. After intraoperative transcatheter arterial embolization (IOTAE) to control hemorrhage, left trisegmentectomy was performed. The patient then underwent chemotherapy, followed by autologous bone marrow transplantation. The hemorrhage from the ruptured tumor was completely arrested by IOTAE, and the postoperative course was uneventful. Hepatic resection after IOTAE, followed by chemotherapy and bone marrow transplantation, represents a promising treatment for ruptured hepatoblastoma.