Management of Spontaneous Rupture in Hepatocellular Carcinoma

Spontaneous rupture of hepatocellular carcinoma represents an acute surgical emergency with high mortality unless promptly recognised and managed. The condition typically presents with sudden onset abdominal pain, signs of hypovolaemic shock and evidence of haemoperitoneum. Immediate priorities include haemodynamic stabilisation with fluid resuscitation and blood transfusion, followed by rapid diagnostic imaging to confirm active bleeding and tumour characteristics. Definitive treatment options hinge on patient liver function, tumour size and location, and resuscitation response. Transarterial embolisation techniques have become first-line haemostatic measures, offering minimally invasive control of bleeding even in patients unfit for open surgery. In suitable candidates with preserved hepatic reserve, one-stage or staged hepatectomy following successful embolisation confers durable local control and improved long-term survival. Radiofrequency ablation and other thermal ablation modalities may serve as adjuncts or bridges to surgery, particularly for haemostatic control during laparotomy. Across diverse healthcare settings, multidisciplinary coordination between interventional radiology, hepatobiliary surgery and critical care underpins optimal outcomes. Prognostic determinants include baseline liver function (often quantified by the Child–Pugh score), maximal tumour diameter, presence of vascular invasion and timing of definitive resection.

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Management of Spontaneous Rupture in Hepatocellular Carcinoma publication trend

The graph below shows the total number of articles in management of spontaneous rupture in hepatocellular carcinoma across all publications each year (not limited to Nature Index journals).

Technical terms

Haemoperitoneum: Accumulation of blood within the peritoneal cavity, often leading to peritoneal irritation and hypovolaemic shock.

Transarterial embolisation (TAE): Endovascular occlusion of tumour feeding vessels to achieve rapid haemostasis without delivery of cytotoxic agents.

Transarterial chemoembolisation (TACE): Combined delivery of chemotherapeutic substances and embolic particles into hepatic arteries supplying the tumour, used for both palliative and bridging purposes.

Radiofrequency ablation (RFA): Use of high-frequency alternating current to induce thermal coagulative necrosis in targeted tumour tissue, sometimes applied intraoperatively for bleeding control.

Child–Pugh score: Clinical scoring system assessing severity of chronic liver disease, incorporating bilirubin, albumin, prothrombin time, ascites and hepatic encephalopathy to guide therapeutic decisions.

Hepatectomy: Surgical resection of a portion of the liver, which may be performed emergently or in a staged fashion following embolisation to manage ruptured tumours.

References

1. Spontaneously Ruptured Hepatocellular Carcinoma: Computed Tomography-Based Assessment. Diagnostics (2023).
2. Ruptured Hepatocellular Carcinoma: Current Status of Research. Frontiers in Oncology (2022).
3. Ruptured Hepatocellular Carcinoma: What Do Interventional Radiologists Need to Know?. Frontiers in Oncology (2022).