Spontaneous rupture of hepatocellular carcinoma in a non-cirrhotic liver

Spontaneous rupture of Hepatocellular Carcinoma (HCC) is a surgical emergency with bad prognosis and poor long-term survival. The correct diagnosis and the appropriate therapeutic approach is a challenge, especially in the Western world, where the incidence of the disease is lower than the Asian countries. We present a 70-year-old male patient who was transferred to the Emergency Department with acute abdominal pain. His medical history included non-insulin dependent diabetes mellitus. His hemoglobin dropped from 11,5g/dl to 8,2g/dl within half an hour, and his blood pressure from 100/80 mmHg to 80/40; therefore a helical computerized tomography was performed, which showed hemoperitoneum and two tumours at the liver segments IVb and VII-VIII, undiagnosed until then. The exploratory laparotomy revealed two bleeding tumours, while the rest of the hepatic parenchyma was normal. Wedge resection on the responsible segments was performed and the histopathological report described HCC on a non-cirrhotic liver. The patient had a normal recovery and was discharged the 9th postoperative day. He had been examined at an outpatient basis every 6 months, he presented a recurrence 1,5 year later, generalized carcinomatosis and succumbed to the disease. This case report describes a normal recovery after the liver resection, due to the non-cirrhotic liver and the good general condition of the patient, which is rare. Most often, spontaneous HCC occurs at cirrhotic patients with multiple comorbidities, and consequently the mortality ranges from 25%