title: Ruptured hepatocellular carcinoma: an important cause of spontaneous haemoperitoneum in Italy.
abstract: OBJECTIVE
  To evaluate the incidence of rupture of the tumour with intraperitoneal bleeding in a series of patients with hepatocellular carcinoma and its relative incidence as a cause of spontaneous haemoperitoneum, and to evaluate the results of the surgical treatment of a consecutive series of patients who presented with spontaneous haemoperitoneum caused by ruptured hepatoma.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital, Italy.
  
  
  METHODS
  8 patients whose hepatocellular carcinoma ruptured (out of a total of 518) and caused spontaneous haemoperitoneum, and 34 patients who were admitted with spontaneous haemoperitoneum.
  
  
  METHODS
  Seven hepatic resections; in one case direct haemostasis was attempted because of the poor hepatic reserve.
  
  
  RESULTS
  Rupture of the tumour with intraperitoneal bleeding occurred in 8/518 (2%) of cases of hepatocellular carcinoma. Ruptured hepatocellular carcinoma was the second most common cause of spontaneous haemoperitoneum (8/34; 24%), after gynaecological diseases (15/34; 44%). Of the 7 patients who presented with ruptured hepatocellular carcinoma and were treated by hepatic resection, 3 are alive (one with a recurrent disease) after a mean follow-up of six months (range 3 to 12 months) and 4 died of carcinomatosis within 12 months. The patient for whom resection was not feasible died immediately postoperatively of irreversible shock.
  
  
  CONCLUSIONS
  Rupture of hepatocellular carcinoma is a relatively common cause of spontaneous haemoperitoneum. Diagnosis at the onset of symptoms has important therapeutic implications: as the results of surgical treatment are unsatisfactory, other procedures with the limited goal of achieving satisfactory haemostasis can be considered if the hepatocellular carcinoma has been diagnosed.
authors.affiliation: Department of Clinical Surgery, University of Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Vivarelli
authors.forename: A
authors.initials: A
authors.lastname: Cavallari
authors.forename: R
authors.initials: R
authors.lastname: Bellusci
authors.forename: E
authors.initials: E
authors.lastname: De Raffele
authors.forename: B
authors.initials: B
authors.lastname: Nardo
authors.forename: G
authors.initials: G
authors.lastname: Gozzetti
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology* / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D007558:Italy; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome