Spontaneous rupture of primary hepatoma: report of 63 cases with particular reference to the pathogenesis and rationale treatment by hepatic artery ligation.

Of 508 cases of primary liver cancer admitted during 1970-1978, 63 cases had spontaneous rupture of carcinomatous nodules. The association with cirrhosis among noncomplicated cases was 65% and 93% in cases with the rupture (P less than 0.001). In most instances, the presenting symptoms were not dramatic and could be indistinguishable from other uncomplicated carcinoma of the liver. Sixteen patients were treated conservatively and all died. The other ten patients who presumably bled due to coagulation defect were also given conservative treatment and the mortality rate was only 60%. Hepatic artery ligation was employed in 26 cases with 54% mortality but bleeding stopped in 92%, as compared with other conventional surgical measures such as packing, suture, and cauterization to control hemorrhage with 90% mortality rate. There is ample evidence that hepatic venous obstruction due to the tumor invasion and portal hypertension due to the pre-existing cirrhosis play important roles in the pathogenesis of spontaneous rupture of the tumor. Hepatic artery ligation is a rationale treatment because it not only cuts off blood supply to the tumor nodule which is almost exclusively nourished by arterial blood, but also reduces the degree of portal hypertension in cirrhosis.