title: Management of spontaneously ruptured hepatocellular carcinoma and hemoperitoneum manifested as acute abdomen in the emergency room.
abstract: BACKGROUND
  Spontaneously ruptured hepatocellular carcinoma (HCC) with hemoperitoneum has a poor prognosis, especially in cases of cirrhosis. Patients usually present to emergency rooms (ERs) with acute abdomen. The aim of the present study was to determine the factors affecting mortality and to compare the prognosis of conservative treatment, transcatheter arterial embolization (TAE), or hepatectomy in these situations.
  
  
  METHODS
  Fifty-four patients with spontaneously ruptured HCC diagnosed between January 2004 and August 2010 were enrolled in this retrospective review of clinical data. Grouping by survival or mortality, univariate and multivariate analyses of factors affecting 30-day mortality, and long-term survival were conducted. The outcomes of the various treatments were analyzed.
  
  
  RESULTS
  After primary fluid resuscitation in the ER, 6 of 54 patients underwent conservative treatment. Emergency hepatectomy was performed on 19 patients; TAE was used for 29 patients, 18 of whom received staged hepatectomy thereafter. Poor liver function, prolonged international normalized ratio (INR), and conservative treatment were associated with increased 30-day mortality. Logistic regression analysis of cumulative survival revealed that INR ≥ 1.4, multiple intrahepatic HCC, and conservative treatment were related to poorer long-term survival. The patients who received hepatectomy, either immediate or staged after TAE, had higher survival rates of 85.2 % at 30 days and 62.2 % at 1 year.
  
  
  CONCLUSIONS
  The treatment of ruptured HCC should be tailored to the individual case. Prolonged survival is possible in patients with preserved liver function through curative liver resection. Emergency physicians, radiologists, and surgeons play essential roles in managing these patients.
authors.affiliation: Division of General Surgery, Department of Surgery, Tungs' Taichung MetroHarbour Hospital, Taichung, Taiwan, ROC. sandersyeh@yahoo.com.tw
authors.forename: Kuan-Chun
authors.initials: KC
authors.lastname: Hsueh
authors.forename: Hsiu-Lung
authors.initials: HL
authors.lastname: Fan
authors.forename: Teng-Wei
authors.initials: TW
authors.lastname: Chen
authors.forename: De-Chuan
authors.initials: DC
authors.lastname: Chan
authors.forename: Jyh-Cherng
authors.initials: JC
authors.lastname: Yu
authors.forename: Shung-Sheng
authors.initials: SS
authors.lastname: Tsou
authors.forename: Tzu-Ming
authors.initials: TM
authors.lastname: Chang
authors.forename: Chung-Bao
authors.initials: CB
authors.lastname: Hsieh
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D004630:Emergencies; D005260:Female; D006465:Hemoperitoneum / Q000150:complications* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D015996:Survival Rate; D055815:Young Adult