title: Acute liver failure, rupture and hemorrhagic shock as primary manifestation of advanced metastatic disease.
abstract: BACKGROUND
  Malignancies rarely cause of acute liver failure, the presence of which have to be ruled-out during transplant evaluation. Tumor-related liver ruptures sporadically occur and might further complicate patient management.
  
  
  METHODS
  We report the case of a previously healthy 56-year-old male with complaints of abdominal pain. Initially, levels of liver enzymes were elevated, however, comprehensive imaging examinations revealed no gross abnormalities. As acute liver failure developed, transplantation was evaluated. Sudden liver rupture and hemorrhage forced the performance of an emergency laparotomy. Hepatectomy was planned, until a donor organ was allocated. Intraoperatively, the liver unexpectedly revealed diffuse tumor infiltration. Without further therapeutical options, the patient died. Immunohistochemistry showed metastatic infiltration of a carcinoma of unknown primary.
  
  
  CONCLUSIONS
  Even in previously healthy patients suffering from acute liver failure, exclusion of malignancies is mandatory before transplantation. As imaging might be misleading, a biopsy should be considered early in unresolved cases.
authors: Department of Surgery, Chirurgische Klinik und Poliklinik, Ludwig Maximilians University Munich, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany. gerhard.preissler@med.uni-muenchen.de
authors: Gerhard
authors: G
authors: Preissler
authors: Christian
authors: C
authors: Graeb
authors: Christian
authors: C
authors: Steib
authors: Christoph J
authors: CJ
authors: Zech
authors: Christoph
authors: C
authors: Weiler
authors: Hans J
authors: HJ
authors: Stemmler
authors: Karl-Walter
authors: KW
authors: Jauch
authors: Norbert H
authors: NH
authors: Gruener
mesh_terms: D006801:Humans; D008099:Liver / Q000293:injuries*; D017114:Liver Failure, Acute / Q000209:etiology / Q000473:pathology*; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012421:Rupture / Q000209:etiology / Q000473:pathology; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000473:pathology*; D014057:Tomography, X-Ray Computed