title: [Massive intrahepatic haemorrhage responsible for an inferior vena cava syndrome: an exceptional complication of hepatocellular carcinoma].
abstract: Intralesional massive haemorrhage responsible for inferior vena cava syndrome is a very rare complication of hepatocellular carcinoma. A 36-year-old man with no past medical history was referred to hospital for abdominal pain with clinical and biological signs of internal bleeding. An abdominal CT scan showed a huge right liver mass, with regular margins and a fluid content, indicating a large intratumoral haemorrhage complicating hepatocellular carcinoma. Due to haemodynamic stability and the signs of inferior vena cava compression conservative management was chosen prior to surgical treatment of the tumour. Three months later, the huge liver mass remained unchanged but the inferior vena cava syndrome had decreased and the patient's condition improved. After evaluation of liver function and the extent of the tumour, a surgical procedure was performed via a subcostal incision with midline extension and sternotomy to control the intrapericardial inferior vena cava and perform a veno-venous bypass with the technique used for orthotopic liver transplantation. Then, right hepatectomy (segments V to VIII) was performed with an anterior approach. The postoperative course was uneventful. This two-step strategy allowed successful surgery for this rare complication of a hepatocellular carcinoma on a normal liver and could be recommended for the management of any unruptured intratumoral haemorrhages.
authors.affiliation: Service de Chirurgie Digestive et de Transplantation Hépatique, Institut de cancérologie Regina Elena, Rome, Italie.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Ettorre
authors.forename: Richard
authors.initials: R
authors.lastname: Douard
authors.forename: Roberto
authors.initials: R
authors.lastname: Santoro
authors.forename: Antonello
authors.initials: A
authors.lastname: Vidiri
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vennarecci
authors.forename: Fabio
authors.initials: F
authors.lastname: Carboni
authors.forename: Arianna
authors.initials: A
authors.lastname: Boschetto
authors.forename: Valerio
authors.initials: V
authors.lastname: Corazza
authors.forename: Michela
authors.initials: M
authors.lastname: Maritti
authors.forename: Mario
authors.initials: M
authors.lastname: Antonini
authors.forename: Eugenio
authors.initials: E
authors.lastname: Santoro
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000601:surgery; D006470:Hemorrhage / Q000150:complications* / Q000601:surgery; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications* / Q000601:surgery; D008297:Male; D013577:Syndrome; D014652:Vascular Diseases / Q000209:etiology*; D014682:Vena Cava, Inferior