Predictors of liver failure after transarterial chemoembolization in patients with spontaneously ruptured hepatocellular carcinoma:A retrospective study

Background: Spontaneously ruptured hepatocellular carcinoma(rHCC) is a life-threatening condition. Transarterial chemoembolization(TACE) is a widely accepted treatment;however, it can lead to serious complications,especially liver failure. We sought to identify preoperative predictors of liver failure in patients with rHCC undergoing TACE.Methods: Patients with rHCC who received TACE as the initial therapy were retrospectively studied at our institution between January 2016 and December 2021. Based on the occurrence of liver failure after TACE, the patients were divided into liver failure and no-liver failure groups. Predictors of liver failure after TACE were analyzed using univariate and multivariate regression analyses. The predictive performance was assessed using the area under the curve(AUC). Delong’s test was used to compare predictive efficiency.Results: Sixty patients(19 and 41 in the liver failure and non-liver failure groups, respectively) were included.Multivariate analysis showed that preoperative prothrombin activity(PTA) level(odds ratio [OR], 0.956;95%confidence interval [CI], 0.920–0.994;P = 0.024) and Child-Pugh grade B(OR, 6.419;95% CI, 1.123–36.677;P= 0.037) were independent predictors of liver failure after TACE in patients with rHCC. The AUCs of the preoperative PTA levels and Child-Pugh grade B for predicting liver failure after TACE in patients with rHCC were0.783 and 0.764, respectively.Conclusion: Preoperative PTA level and Child-Pugh grade B were significant independent risk factors for liver failure after TACE in patients with rHCC. These can be used to predict liver failure after TACE in patients with rHCC for individual decision-making regarding treatment planning.

Spontaneous coronary artery rupture after lung cancer surgery:A case report and review of literature

BACKGROUND Spontaneous coronary artery rupture(SCAR)is a rare and life-threatening complication after lung cancer surgery.We present a case of SCAR following left upper lobectomy,successfully managed through emergency thoracotomy and coronary artery ligation.CASE SUMMARY A 61-year-old male patient underwent left upper lobectomy and mediastinal lymph node dissection for lung cancer.The surgery was performed using singleport video-assisted thoracoscopic surgery,and there were no observed complications during the procedure.However,19 h after surgery,the patient experienced chest discomfort and subsequently developed severe symptoms,including nausea,vomiting,and a drop in blood pressure.Urgent measures were taken,leading to the diagnosis of SCAR.The patient underwent emergency thoracotomy and coronary artery ligation,successfully stopping the bleeding and stabilizing the condition.Despite postoperative complications,the patient made a successful recovery and was discharged from the hospital.CONCLUSION SCAR is a rare but life-threatening complication following lung cancer surgery.Immediate thoracotomy has been shown to be a life-saving measure,while stenting is not the preferred initial approach.

Metabolic imaging for guidance of curative treatment of isolated pelvic implantation metastasis after resection of spontaneously ruptured hepatocellular carcinoma: A case report

Spontaneous rupture of hepatocellular carcinoma(HCC) is a life-threatening complication and its prognosis is significantly poor because of the high recurrence rate after initial hepatectomy. Resection of isolated extrahepatic metastasis of HCC has been advocated to obtain a possibility of long-term survival. However, it is a challenge for clinicians to detect implantation metastasis of spontaneously ruptured HCC. Accurate re-staging plays the most important role in making a decision on isolated metastasis resection. 18F-fluorodeoxyglucose(18F-FDG) positron emission tomography/computed tomography(PET/CT) is useful in detecting intraabdominal implantation metastasis from a variety of malignancies and shows superior accuracy to conventional imaging modalities in determining the location of metastasis. We present one patient with a new isolated pelvic implantation metastasis detected by 18F-FDG PET/CT and pathologically confirmed by PET/CT-guided percutaneous biopsy, who had a history of resection of spontaneously ruptured HCC two years ago. The patient's condition was stable at the 6-mo follow-up after resection of the isolated pelvic metastasis.

Spontaneous Rupture of Urinary Bladder (SRUB): An Exceptional Presentation

Background: Spontaneous rupture of urinary bladder (SRUB) without trauma is an extremely rare pathology. The incidence is estimated to about 1/126,000. It is difficult to diagnose. Aim: To present an exceptional case report and emphasize on the difficulty of diagnosis. Case Presentation: We report the case of a 63-year-old man. The initial diagnosis of SRUB was obscured by a urinary retention. The pelvic ultrasound finally led to the diagnosis. We will pay particular attention to the circumstances of the diagnosis and the therapeutic measures applied. Conclusion: SRUB is exceptional and misdiagnosis is usual. Management is most of the time surgical.

Do we really need a standardized approach to spontaneously ruptured hepatocellular carcinoma?

Hepatocellular carcinoma(HCC)is one of the leading causes of cancer-related death in Asian and African countries due to a high prevalence of chronic hepatitis B infections(1,2).The vast majority of current studies focus on the treatment of HCC itself rather than complications from HCC.A potentially life-threatening complication of HCC is spontaneous rupture,and its prevalence has been reportedly to be 5-15%of all HCC cases(1).This is the third leading cause of HCC-related death after tumor progression and liver failure,and there is a high mortality associated with rupture(3,4).

Feasibility and safety of sorafenib treatment in hepatocellular carcinoma patients with spontaneous rupture

AIM: To report the outcome of patients with ruptured hepatocellular carcinoma (HCC) treated at a single center during a 5-year period.

Risk factor analysis of perioperative mortality after ruptured bleeding in hepatocellular carcinoma

AIM: To discuss strategies and prognosis for the emergency treatment of ruptured bleeding in primary hepatocellular carcinoma.

Hydrochloric acid-enhanced radiofrequency ablation for treating a large hepatocellular carcinoma with spontaneous rapture:a case report

Background:A ruptured hepatocellular carcinoma(HCC)is often fatal.In addition to surgery and transarterial embo?lization,radiofrequency ablation(RFA)might be another option for treating a ruptured HCC.Unfortunately,conven?tional RFA has a limited ablation zone;as such,it is rarely used to treat ruptured tumors.Case presentation:This case was a 60?year?old man who had a large,ruptured HCC in which hydrochloric acid(HCl)?enhanced RFA successfully controlled the bleeding and made the tumor completely necrotic.Conclusion:Considering the effectiveness of HCl?enhanced RFA in achieving hemostasis and tumor ablation,it might be a new option for treating large,ruptured HCCs.

Spontaneous rupture of hepatic epithelioid hemangioendothelioma: A case report

Hepatic epithelioid hemangioendothelioma(HEH) is a rare tumor of vascular endothelial origin. Spontaneous rupture of HEH is a life-threatening complication and is extremely rare. HEH has variable malignant potential, and the clinical diagnosis remains challenging. Here we report a case of HEH with spontaneous rupture. A 44-year-old man presented with constant cutting pains over the right upper abdomen after eating. He had hemoptysis 11 d previously. Diagnostic abdominal puncture demonstrated active bleeding. Chest and abdominal computer tomography scan showed multiple ground-glass nodules over the lungs, multiple low-density intrahepatic nodules and massive hemorrhage. Transcatheter arterial embolization and exploratory laparotomy were performed and subsequent immunohistochemical examination confirmed a diagnosis of HEH.

Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma

AIM:To determine the risk factors for hepatocellular carcinoma(HCC) rupture,and report the management and long-term survival results of patients with spontaneous rupture of HCC.METHODS:Among 4209 patients with HCC who were diagnosed at Eastern Hepatobiliary Surgery Hospital from April 2002 to November 2006,200(4.8%) patients with ruptured HCC(case group) were studied retrospectively in term of their clinical characteristics and prognostic factors.The one-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative treatment,transarterial embolization(TACE) or hepatic resection.Results of various treatments in the case group were evaluated and compared with the control group(202 patients) without ruptured HCC during the same study period.Continuous data were expressed as mean ± SD or me-dian(range) where appropriate and compared using the unpaired t test.Categorical variables were compared using the Chi-square test with Yates correction or the Fisher exact test where appropriate.The overall survival rate in each group was determined using the Kaplan-Meier method and a log-rank test.RESULTS:Compared with the control group,more patients in the case group had underlying diseases of hypertension(7.5% vs 3.0%,P =0.041) and liver cirrhosis(87.5% vs 56.4%,P < 0.001),tumor size >5 cm(83.0% vs 57.4%,P < 0.001),tumor protrusion from the liver surface(66.0% vs 44.6%,P < 0.001),vascular thrombus(30.5% vs 8.9%,P < 0.001) and extrahepatic invasion(36.5% vs 12.4%,P < 0.001).On multivariate logistic regression analysis,underlying diseases of hypertension(P = 0.002) and liver cirrhosis(P < 0.001),tumor size > 5 cm(P < 0.001),vascular thrombus(P = 0.002) and extrahepatic invasion(P < 0.001) were predictive for spontaneous rupture of HCC.Among the 200 patients with spontaneous rupture of HCC,105 patients underwent hepatic resection,33 received TACE,and 62 were managed with conservative treatment.The median survival time(MST) of all patients with spontaneous rupture of HCC was 6 mo(range,1-72 mo),and the overall survival at 1,3 and 5 years were 32.5%,10% and 4%,respectively.The MST was 12 mo(range,1-72 mo) in the surgical group,4 mo(range,1-30 mo) in the TACE group and 1 mo(range,1-19 mo) in the conservative group.Ninety-eight patients in the control group underwent hepatic resection,and the MST and median diseasefree survival time were 46 mo(range,6-93 mo) and 23 mo(range,3-39 mo) respectively,which were much longer than that of patients with spontaneous rupture of HCC undergoing hepatic resection(P < 0.001).The 1-,3-,and 5-year overall survival rates and the 1-,3-and 5-year disease-free survival rates in patients with ruptured HCC undergoing hepatectomy were 57.1%,19.0% and 7.6%,27.6%,14.3% and 3.8%,respectively,compared with those of 77.1%,59.8% and 41.2%,57.1%,40.6% and 32.9% in 98 patients with-CONCLUSION:Prolonged survival can be achieved in selected patients undergoing one-stage hepatectomy,although the survival results were inferior to those of the patients without ruptured HCC.

Spontaneous rupture of splenic hamartoma in a patient with hepatitis C virus-related cirrhosis and portal hypertension:A case report and review of the literature

Spontaneous rupture is a rare complication of splenic hamartoma. A review of the literature revealed only four such cases. To the best of our knowledge, this is the first report of spontaneous rupture of splenic hamartoma associated with liver cirrhosis and portal hypertension. A 53-year-old woman, who was followed up for aortic dissection and hepatitis C virus （HCV）-related liver cirrhosis, was referred with sudden left chest and shoulder pain. An abdominal ultrasound showed intraabdominal bleeding, and computed tomography indicated rupture of a splenic tumor. Emergent splenectomy was carried out. The postoperative course was uneventful, and the patient was discharged on the 13th postoperative day. Pathology revealed the tumor to be a ruptured splenic hamartoma. The non-tumorous splenic parenchyma revealed congestive changes. We consider that the presence of liver cirrhosis and portal hypertension are risk factors for spontaneous rupture of the splenic hamartoma.

Spontaneous liver rupture in a patient with peliosis hepatis:A case report

Peliosis hepatis is a rare pathological entity and may cause fatal hepatic hemorrhage and liver failure.Here, we present a young male patient with aplastic anemia,who had received long-term treatment with oxymetholone.The patient suffered from sudden onset of intra-abdominal hemorrhage with profuse hemoperitoneum.The patient was treated successfully with a right hemihepatectomy and is in good health after 13 postoperative months.We suggest that peliosis hepatis be considered in patients with hepatic parenchymal hematoma,especially in patients under prolonged synthetic anabolic steroid medication.The possibility of a potentially life-threatening complication of massive intra-abdominal bleeding should also be considered.

Spontaneous rupture of a hepatic hydatid cyst into the peritoneum causing only mild abdominal pain:A case report

Hydatid disease is an endemic disease in certain areas of the world. It is located mostly in the liver. Spontaneous rupture of the hydatid cyst into the peritoneum is a rare condition, which is accompanied by serious morbidity and mortality generally. We present herein a case with a spontaneous rupture of a hepatic hidatid disease into the peritoneum without any serious symptoms. A 15-year- old boy was admitted to the emergency room with a mild abdominal pain lasting for a day. Physical examination revealed only mild abdominal tenderness. There was no history of trauma or complaints related to hydatid diseases. Ultrasonography showed a large amount of free fluid and a cystic lesion with irregular borders in the liver. He was operated on. Postoperative albendazol therapy was given for 2 mo. No recurrence or secondary hydatidosis was seen on CT investigation in the 3^th, 6^th and 12^th mo following surgery.

Spontaneous rupture of hepatocellular carcinoma: a retrospective study of 87 patients in a teaching hospital

Objective: The aim of the study was to review the management of ruptured hepatocellular carcinoma (HCC) in a single teaching hospital over 13-year period; to determine the prognostic factor of in-hospital mortality and evaluate the safety and efficacy of liver resection. Methods: A retrospective collection of medical records of 87 patients with spontaneous ruptured HCC was carried out. The 28 patients underwent emergency intervention including transarterial chemoembolization (TACE) and laparotomy with/without liver resection. Conservative treatment was performed in 59 patients and 16 of which underwent delayed hepatectomy or TACE. Results: The overall in-hospital mortality and median survival time was 54% and 22 days respectively. Albumin level (OR = 0.874, 95% CI: 0.778-0.973, P = 0.024), number of tumors (OR = 5.011, 95% CI: 1.015-24.750, P = 0.048) and laparotomy (OR = 0.069, 95% CI: 0.012-0.406, P = 0.003) were all independent factors affecting overall in-hospital mortality, but for patients undergone laparotomy, only total bilirubin level (OR = 1.138, 95% CI: 1.024-1.264, P = 0.016) was independent factor affecting overall in-hospital mortality. Age, total bilirubin level, maximum tumor size, number of tumors, portal vein tumor thrombosis and extra-hepatic metastasis were all significantly different between groups with laparotomy and without. There were no significant differences between emergency and delayed liver resection groups in in-hospital mortality (0 vs. 0), median survival time (788 vs. 750 days respectively) as well as 1-year and 3-year survival rates (66.7%, 44.4% vs. 70%, 30%, respectively) (P = 0.763, log-rank test). Conclusion: Both underlying chronic liver disease and tumor stage can affect the in-hospital mortality, but for patients undergone laparotomy, only total bilirubin level is independent factor. Surgeons are more prone to choose patients with younger age, better liver function and earlier tumor stage to do surgery. In well selected patients, both emergency and delayed liver resections are safe and could achieve prolonged survival.

Recurrent ascites due to spontaneous intraperitoneal bladder rupture after pelvic radiation therapy for cervical cancer

Radiation cystitis is one of the major complications following radiotherapy for cervical cancer. However, spontaneous intraperitoneal bladder rupture as a result of radiation cystitis following radiotherapy for cervical cancer is extremely rare. Case presentation: We report a 52-year-old patient who received radiation therapy for cervical cancer 15 years prior to presentation. Eight years prior to presentation, she developed recurrent abdominal distension, oliguria, and ascites. Following ascites drainage and supportive treatment, all symptoms were relieved. However, all symptoms subsequently recurred every few months. The patient underwent exploratory laparotomy twice. The first exploratory laparotomy in July 2015 found no specific abnormalities. The second exploratory laparotomy in November 2016 found an intraperitoneal bladder rupture, and the patient underwent surgical repair. The ascites subsequently resolved. Conclusion: The occurrence of spontaneous intraperitoneal bladder rupture after radiation therapy for cervical cancer is rare. The prognosis is good when diagnosis and treatment are prompt.

Spontaneous liver rupture as first sign of polyarteritis nodosa

Polyarteritis nodosa(PAN) is one of the systemic vasculitis that affects the media wall of arteries of small and medium diameter. Diagnosis proves difficult due to the unspecific symptoms that dominate the clinical profile. Liver involvement is very diverse, ranging from the development of cirrhotic liver disease to acute abdomen presentation that requires surgery because of liver rupture. The management of these patients requires an expert multidisciplinary team. There are several cases in the literature that describe a sudden liver rupture as the first manifestation of a PAN. In this paper we present the case of a 75 years old patient without any previous disease, who is subjected to major hepatic resection for spontaneous liver rupture.

Spontaneous rupture of the liver in a patient with chronic hepatitis B and D

Spontaneous rupture of the liver is a rare condition with serious consequences,if not recognized and treated in time. It has been reported as a complication of several disorders,including benign or malignant liver tumors,connective tissue disease,infiltrating liver disease,preeclampsia,and post anticoagulant therapy. We report a case of spontaneous rupture of liver in a non-cirrhotic,chronic hepatitis B and D patient presenting with acute hemoperitoneum and shock. The subcapsular hematoma and rupture of liver were documented by image studies. The patients' condition gradually stabilized after fluid resuscitation. The reported case and literature review suggest that spontaneous rupture of liver must be considered in a differential diagnosis of acute hemoperitoneum. A high index of suspicion and early diagnosis with imaging are critically important.

Treatment of A Case of Spontaneous Rupture of Achille's Tendon

Mr. Guo, 51 years old, paid his first visit on November 7, 2001. The patient felt sudden pain in the right Achille's tendon in June 1999 with no apparent predisposing factors. Several months later he palpated a small pitting in the middle of the right Achille's tendon, which expanded gradually in size. In June 2000, two thirds of the tendon was diagnosed to be ruptured in a local hospital. Ten days later the tendon was ruptured completely when he felt sudden severe pain, numbness and distention, and he was unable to raise the heel. The lesion was healed three months later after being treated with a plaster model, but it was partially ruptured again 6 months later. Though the ruptured tendon was healed again with the help of a plaster model, he still suffered from local swelling and pain, which was aggravated during movement and made him difficult in walking, squatting down and standing up. During the examination, the right heel was found hyperemic and swollen with ecchymosis and tenderness. The tongue proper was dark red and the pulse thready and rapid. The condition was due to depletion and deficiency of liver-qi, stagnant blood with dampheat obstructing the collaterals. The principle of nourishing the liver and soothing the tendon was adopted, assisted by invigorating blood circulation and removing blood stasis, clearing heat and transforming dampness.

Influence of regional background stress fields on the spontaneous rupture of the major faults around Xiluodu dam,China

Simulations of the spontaneous rupture of potential earthquakes in the vicinity of reservoir dams can provide accurate parameters for seismic resilience assessment,which is essential for improving the seismic performance of reservoir dams.In simulations of potential spontaneous ruptures,fault geometry,regional stress fields,constitutive parameters of the fault friction law,and many other factors control the slip rate,morphology,and dislocation of the rupture,thereby affecting the simulated ground motion parameters.The focus of this study was to elucidate the effects of the background stress field on the nucleation and propagation of spontaneous ruptures based on the factors influencing potential M>7 earthquake events on the Leibo Middle Fault(LBMF)and the Mabian-Yanjing Fault(MB-YJF)in the Xiluodu dam(XLD)region.Our simulation results show that the magnitude of the regional background stress field plays a decisive role in whether a destructive earthquake exceeding the critical magnitude will occur.We found that the direction and magnitude of the regional stress significantly affect the range of rupture propagation on the fault plane,and fault geometry affects the spatial distribution of the rupture range.Under the same regional stress field magnitude and orientation,a more destructive,high-magnitude earthquake is more likely to occur on the LBMF than on the MB-YJF.