title: Peritoneal implanted hepatocellular carcinoma with rupture after TACE presented as acute appendicitis.
abstract: We are reporting a rare case of peritoneal implanted hepatocellular carcinoma with rupture after transarterial chemoembolization mimicking acute appendicitis. A 45-year-old male patient presented with fever and manifestations of acute appendicitis. He received transarterial chemoembolization for hepatocellular carcinoma two months before. Emergent exploratory laparotomy revealed a normal appendix, a ruptured nodule located at the serosal surface of the terminal ileum with hemoperitoneum, and ruptured hepatocellular carcinoma at the junction of segments 4 and 8 of the liver. There was no peritoneal carcinomatosis, direct invasion to the surrounding tissue, or lymph node involvement. Postoperative course was uneventful. Histopathological examination of the resected nodule revealed metastatic hepatocellular carcinoma.
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan. ycn@adm.cgmh.com.tw
authors.forename: Chun-Nan
authors.initials: CN
authors.lastname: Yeh
authors.forename: Han-Ming
authors.initials: HM
authors.lastname: Chen
authors.forename: Miin-Fu
authors.initials: MF
authors.lastname: Chen
authors.forename: Tzu-Chieh
authors.initials: TC
authors.lastname: Chao
mesh_terms: D000006:Abdomen, Acute / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D000208:Acute Disease; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D003937:Diagnosis, Differential; D006801:Humans; D007078:Ileal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D010537:Peritoneum / Q000473:pathology; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed