title: Emergency embolization in the treatment of ruptured hepatocellular carcinoma following transcatheter arterial chemoembolization.
abstract: OBJECTIVE
  Rupture of hepatocellular carcinoma (HCC) following transcatheter arterial chemoembolization (TACE) is a rare and life-threatening complication. The purpose of the present study was to evaluate the utility of emergency embolization for treatment of ruptured HCC following TACE.
  
  
  METHODS
  Five patients developed rupture of tumor after TACE in 1005 patients of HCC from October 2007 to February 2010, and were studied retrospectively. Emergency selective arterial embolization was performed in all 5 patients because of intractable hemorrhage in the peritoneal cavity or around the liver that could not be controlled by conservative method. The mean hemoglobin level before embolization was 75.6 g/L +/- 20.7 (mean +/- standard deviation).
  
  
  RESULTS
  Hepatic angiography did not revealed extravasation of contrast from the tumor in all 5 patients with rupture of HCC following TACE. After selective embolization of feeding arteries of the liver tumor, intraperitoneal bleeding from HCC was stopped immediately in all patients. The mean hemoglobin level after embolization in 48 hours was 102.6 g/L +/- 3.5. No severe complication related to emergency embolization was found after treatment.
  
  
  CONCLUSIONS
  Emergency arterial embolization is effective for hemostasis of ruptured HCC following TACE in patients with hemodynamically unstable condition.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
authors.forename: Jun-Hui
authors.initials: JH
authors.lastname: Sun
authors.forename: Li-Gang
authors.initials: LG
authors.lastname: Wang
authors.forename: Hai-Wei
authors.initials: HW
authors.lastname: Bao
authors.forename: Jian-Liang
authors.initials: JL
authors.lastname: Lou
authors.forename: Li-Xia
authors.initials: LX
authors.lastname: Cai
authors.forename: Chao
authors.initials: C
authors.lastname: Wu
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Chen
authors.forename: Shu-Sen
authors.initials: SS
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000379:methods*; D004630:Emergencies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous