Surgical treatment in a patient with multiple implanted intraperitoneal metastases after resection of ruptured large hepatocellular carcinoma.

We report a case with multiple disseminated intraperitoneal metastases caused by the rupture of large hepatocellular carcinoma. A 52-year-old man was admitted due to sudden abdominal pain with progressive abdominal distention. Computed tomography showed a 5x7-cm low-attenuation mass in the right hepatic lobe and hemoperitoneum was demonstrated. He was taken for emergency hepatic angiography and hepatic arterial chemoembolization was done. Ten days after embolization, right lobectomy was performed successfully. Microscopic examination confirmed hepatocellular carcinoma. After 4 months, follow-up computed tomography showed a 2-cm-sized irregular-shaped mass at the right great omentum. A second surgery for omentectomy with mass excision was performed. Three months later, splenectomy and segmental resection of the colon was performed. Five months later, metastatic lymph node was detected around the head of the pancreas. Mass excision was then performed. Microscopically, all resected tumors were confirmed as metastatic hepatocellular carcinoma. The patient underwent resection of multiple intraperitoneal metastases three times for 1 year after resection of ruptured hepatocellular carcinoma and is currently disease free for 15 months. Hepatic resection is the treatment of choice for ruptured hepatocellular carcinoma but dissemination of tumor cells in the peritoneal cavity should be kept in mind. Even if intraperitoneal metastases develop, long-term survival could be possible with aggressive surgical treatment.