title: Liver radiofrequency ablation as emergency treatment for a ruptured hepatocellular carcinoma: a case report.
abstract: BACKGROUND
  Hemoperitoneum is a possible complication of hepatocellular carcinoma that may require emergency surgery as an alternative to radiological locoregional therapies.
  
  
  METHODS
  We present a case report of a 78-year-old white man with alcoholic-related cirrhosis and a multifocal hepatocellular carcinoma. An abdominal computed tomography scan showed multiple and bilateral foci of bleeding from broken liver cancer. He was urgently transferred from our radiology unit to our operating room for massive hemoperitoneum. A middle line laparotomy detected a massive hemoperitoneum. His liver was cirrhotic and completely subverted by a tumor; there were two spontaneous bleeding lacerations on segments II and IV, which were uncontrollable with conventional hemostatic techniques. Therefore, it was decided to carry out the coagulation of the multiple vascular afferents of each single mass by means of radiofrequency ablation cycles performed circumferentially on both nodules for a total of 40 minutes. Hemostasis was achieved; the radiofrequency ablation controlled the bleeding from his ruptured hepatocellular carcinoma. He was transferred to our intensive care unit for postoperative monitoring in terms of hemodynamic stability. On postoperative day 2 he was discharged from our intensive care unit.
  
  
  CONCLUSIONS
  Multifocal bleeding hepatocellular carcinoma still has an extremely high mortality. The angiographic control of multiple bilateral bleeding lesions can be extremely difficult and can be contraindicated by the location of the lesions and by the overall clinical condition of the patient. In this case, treatment with radiofrequency ablation has proven to be effective in the control of multiple and bilateral hepatic lesions. This particular technique allowed us to attack the lesion at the level of the vascular pedicle in order to control the bleeding.
authors.affiliation: Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy.|Department of Surgery, Division of Transplantation and Immunology, Yale University, New Haven, Connecticut, USA.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bertacco
authors.affiliation: Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy. drdamico@hotmail.com.|Department of Surgery, Division of Transplantation and Immunology, Yale University, New Haven, Connecticut, USA. drdamico@hotmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Amico
authors.affiliation: Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Romano
authors.affiliation: Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Finotti
authors.affiliation: Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.affiliation: Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000473:pathology; D017115:Catheter Ablation / Q000379:methods*; D004638:Emergency Treatment; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006487:Hemostasis; D006801:Humans; D007813:Laparotomy; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology; D008297:Male; D014057:Tomography, X-Ray Computed
keywords: Case report; HCC ruptured; Liver bleeding; Radiofrequency ablation