Hepatosellüler karsinomada spontan intraperitoneal hemorajik rüptür: Olgu sunumu
Hepatosellüler karsinomada spontan intraperitoneal hemorajik rüptür: Olgu sunumu
Yazar: Ulaş, Murat; Özer, İlter; Öter, Volkan; Aksoy, Erol; Sakaoğulları, Şükran; Bostancı, Erdal
Dergi: Cumhuriyet Tıp Dergisi, Vol. 36 No. 3, 2013
Anahtar kelimeler: Hepatocellular carcinoma, spontaneous rupture, therapeutic ; Hepatosellüler karsinoma, spontan rüptür, tedavi

ÖzetHepatosellüler karsinomun (HSK) intraperitoneal hemorajik rüptürü, ölümle seyredebilen bir komplikasyondur. Seçilmiş vakalarda ana tedavi seçenekleri cerrahi girişim ve arteriel embolizasyondur. Bu yazıda hepatosellüler karsinomun spontan rüptürü sonrası gelişen intraperitoneal kanamalı olgu sunulmuştur. Karın ağrısı ve hemorajik şok tablosunda dış merkezde acile başvurmuş 70 yaşında bir erkek hastadır. Karaciğerde intraperitoneal hemorajik rüptüre kitle nedeni ile sütür ile hemostaz ve packing ile ilk müdahalesi yapılan hasta daha sonra tarafımızca genel durumu ve vital bulguları düzeltilerek tekrar operasyona alınmış depacking sonrası karaciğer segment 4b rezeksiyonu ve kolesistektomi operasyonu yapılmıştır. Hastanın postoperatif dönemde patoloji sonucu iyi differansiye hepatosellüler karsinom olarak gelmiş olup bu olguda olduğu gibi yeterli tıbbi ve teknik ekipman olmadığında ilk cerrahi müdahale (sütürasyon ile hemostaz ve packing) sonrası ileri bir merkezde elektif cerrahi tedavi yaklaşımı da hayat kurtarıcı olabilir.Anahtar sözcükler: Hepatosellüler karsinoma, spontan rüptür, tedavi Abstractİntraperitoneal hemorajic rupture is a complication of hepatocellular carcinoma that can be mortal. Surgical management and arterial embolisation are the main therapy choices in selected cases. We presented a case of hepatocellular carcinoma with spontaneous rupture and intra-abdominal hemorrhage. A 70 years old male was admitted to emergency department with abdominal pain and unstable hemodynamy. Patient was taken the operation room due to intra-abdominal bleeding. İntraoperatif diagnosis was rupture haemorrhagic solid liver mass and they performed depacking and hemostasis. Then they decided to transport patient to our hospital (tertiary hospital). We perform depacking, liver segment resection (4b) and cholecystectomy operation. The histopathological examination for the resected specimen yielded the final diagnosis of well-differentiated hepatocellular carcinoma. As in this case if there is not enough medical and technical equipment for curative surgery than after the first surgical intervention has been done transporting the patient to a tertiary hospital for curative surgery can be saving life.Keywords: Hepatocellular carcinoma, spontaneous rupture, therapeutic

İntraperitoneal hemorajic rupture is a complication of hepatocellular carcinoma that can be mortal. Surgical management and arterial embolisation are the main therapy choices in selected cases. We presented a case of hepatocellular carcinoma with spontaneous rupture and intra-abdominal hemorrhage. A 70 years old male was admitted to emergency department with abdominal pain and unstable hemodynamy. Patient was taken the operation room due to intra-abdominal bleeding. İntraoperatif diagnosis was rupture haemorrhagic solid liver mass and they performed depacking and hemostasis. Then they decided to transport patient to our hospital (tertiary hospital). We perform depacking, liver segment resection (4b) and cholecystectomy operation. The histopathological examination for the resected specimen yielded the final diagnosis of welldifferentiated hepatocellular carcinoma. As in this case if there is not enough medical and technical equipment for curative surgery than after the first surgical intervention has been done transporting the patient to a tertiary hospital for curative surgery can be saving life.