PURPOSE: The aim of this study was to identify the prognostic factors and compare the long-term outcomes of staged hepatectomy and transarterial chemoembolization (TACE) for patients with spontaneous rupture of hepatocellular carcinoma (HCC). METHODS: This study is a multicenter, retrospective analysis of patients with newly diagnosed ruptured HCC. To compare overall survival between staged hepatectomy group and TACE alone group, we performed propensity score-matching to adjust for significant differences in patient characteristics. To identify prognostic factors, the clinical characteristics at the time of diagnosis of tumor rupture were investigated using Cox-regression analysis. RESULTS: From 2000 to 2014, 172 consecutive patients with newly diagnosed ruptured HCC were treated in 6 Korean centers. One hundred seventeen patients with Child-Pugh class A disease were identified; of which 112 were initially treated with transcatheter arterial embolization (TAE) for hemostasis and five underwent emergency surgery for bleeder ligation. Of the 112 patients treated with TAE, 44 underwent staged hepatectomy, 61 received TACE alone, and 7 received conservative treatment after TAE. Those that underwent staged hepatectomy had significantly higher overall survival than those that underwent TACE alone before matching (P < 0.001) and after propensity score-matching (P = 0.006). Multivariate analysis showed that type of treatment, presence of portal vein thrombosis, pretreatment transfusion >1,200 mL, and tumor size >5 cm were associated with poor overall survival. CONCLUSION: Staged hepatectomy may offer better long-term survival than TACE alone for spontaneous rupture of HCC. Staged hepatectomy should be considered in spontaneous rupture of HCC with resectable tumor and preserved liver function.
Carcinoma, Hepatocellular ; Chemoembolization, Therapeutic ; Diagnosis ; Emergencies ; Hemostasis ; Hepatectomy ; Humans ; Korea ; Ligation ; Liver ; Multivariate Analysis ; Retrospective Studies ; Rupture ; Rupture, Spontaneous ; Venous Thrombosis

Spontaneous rupture with internal bleeding of solid tumors has rarely been described at the time of diagnosis or during chemotherapy. This rare event must be regarded as a life threatening condition. In these emergency situations, control of hemorrhage, which is life-saving, can be achieved by transcatheter arterial embolization (TAE) and/or surgical resection. This report describes two infants presenting with acute hemorrhagic shock due to spontaneous tumor rupture of hepatoblastoma and neuroblastoma during chemotherapy. TAE successfully arrested the tumor bleeding and a visibly reduced the tumor size in both children. Spontaneous rupture of solid tumors occur infrequently in children, but is a life threatening situation. Careful monitoring for the occurrence of this rare event especially in very young children presenting with a large tumor mass.
Child ; Diagnosis ; Drug Therapy ; Emergencies ; Hemorrhage ; Hepatoblastoma ; Humans ; Infant ; Neuroblastoma ; Rupture ; Rupture, Spontaneous ; Shock, Hemorrhagic

Gallbladder (GB) cancer is asymptomatic in nature, making diagnosis and treatment difficult. The lymph node status is the strongest predictor of long-term survival for patients with GB cancer, and a complete removal of regional lymph nodes is important for patients undergoing radical resection of GB cancer. Unfortunately, lymph node metastases are common in the early stages of GB cancer. However, there have only been a few cases describing the symptoms or complications of metastatic lymph nodes in patients with GB cancer. Although hemoperitoneum caused by metastatic lymph nodes can occur with several cancers, it is very rare. To the best of our knowledge, hemoperitoneum from spontaneous ruptures of metastatic lymph nodes with GB cancer has not yet been reported. Herein, we describe such a case in a patient newly diagnosed with GB cancer.
Diagnosis ; Gallbladder Neoplasms* ; Gallbladder* ; Hemoperitoneum* ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Rupture ; Rupture, Spontaneous*

A 31-year-old male visited a local hospital due to sudden-onset severe abdominal pain. Abdominal computed tomography revealed a solid cystic mass with a size of approximately 12 cm and exhibiting both hemorrhage and fluid collection in the pelvic cavity. Emergency angiography and embolization were performed, and a large hepatic tumor was subsequently surgically resected. The tumor cells stained positive for human melanoma black-45 and smooth-muscle actin, and the pathologic diagnosis was hepatic angiomyolipoma. This case report also discusses the spontaneous rupture of a hepatic angiomyolipoma.
Abdominal Pain ; Actins ; Adult ; Angiography ; Angiomyolipoma* ; Diagnosis ; Emergencies ; Hemorrhage ; Humans ; Liver ; Male* ; Melanoma ; Rupture, Spontaneous

Spontaneous rupture of intrahepatic cholangiocarcinoma is rare due to its abundant fibrous stroma. We report our experience in a case of spontaneous rupture of intrahepatic cholangiocarcinoma in a pregnant patient. In our case, multiple hepatic masses with intratumoral hemorrhage were noted on post-delivery computed tomography and magnetic resonance imaging and they caused hemoperitoneum. A right hemi-hepatectomy was carried out to control the bleeding and the diagnosis of intrahepatic cholangiocarcinoma with metastasis was performed.
Bile Ducts, Intrahepatic ; Cholangiocarcinoma* ; Diagnosis ; Hemoperitoneum ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Pregnancy ; Rupture ; Rupture, Spontaneous*

Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted.
Abdomen ; Abdominal Pain ; Aged ; Diagnosis ; Drainage ; Female ; Humans ; Incidence ; Laparotomy ; Magnetic Resonance Imaging ; Peritoneal Lavage ; Peritonitis ; Postmenopause ; Pyometra* ; Rupture, Spontaneous ; Uterus ; Vaginal Discharge

Aged ; Female ; Humans ; Kidney Pelvis ; pathology ; surgery ; Rupture, Spontaneous ; diagnosis ; etiology ; surgery ; Ureteral Calculi ; complications ; diagnosis ; surgery ; Ureteral Obstruction ; complications ; diagnosis ; surgery

Non-traumatic, spontaneous urinary bladder rupture is a rare complication of urethral stricture. Furthermore, its symptoms are often nonspecific, and misdiagnosis is common. The authors experienced a case of urethral stricture with spontaneous bladder rupture and bilateral hydronephrosis, mimicking obstructive uropathy attributed to cancer metastasis. A 55-year-old woman was admitted with abdominal pain and distension, oliguria, and an elevated serum creatinine level. She had undergone radical hysterectomy for uterine cervical cancer and received post-operative concurrent chemoradiation therapy 13 years previously. Non-contrast enhanced computed tomography showed massive ascites and bilateral hydronephrosis. The initial diagnosis was acute kidney injury due to obstructive uropathy caused by malignant disease. After improvement of her renal function by bilateral percutaneous nephrostomy catheterization, contrast-enhanced computed tomography and a cytologic examination of ascites showed no evidence of malignancy. However, during retrograde pyelography, a severe urethral stricture was found, and subsequent cystography showed leakage of contrast into the peritoneal cavity and cystoscopy revealed a defect of the posterior bladder wall. After urethral dilatation and primary closure of the bladder wall, acute kidney injury and ascites were resolved.
Abdominal Pain ; Acute Kidney Injury ; Ascites ; Catheterization ; Catheters ; Creatinine ; Cystoscopy ; Diagnosis ; Diagnostic Errors ; Dilatation ; Female ; Humans ; Hydronephrosis ; Hysterectomy ; Middle Aged ; Neoplasm Metastasis* ; Nephrostomy, Percutaneous ; Oliguria ; Peritoneal Cavity ; Radiotherapy ; Rupture* ; Rupture, Spontaneous ; Urethral Stricture* ; Urinary Bladder* ; Urography ; Uterine Cervical Neoplasms

PURPOSE: The main purpose of this study was to achieve a broad perspective of the clinical problem with regard to its overall presentation and relation to anticoagulant and antiplatelet therapy, and to describe common management strategies and clinical outcomes. METHODS: We initially screened 262 patients who were admitted from the Emergency Department between June, 1996 and June, 2013, with International Classification of Diseases code of K66.1 (hemoperitoneum), R58 (retroperitoneal hemorrhage) and D68.3 (hemorrhagic disorder due to anticoagulants). We excluded patients with retroperitoneal hemorrhage (RH) associated with trauma, vascular lesions, tumors, liver cirrhosis, renal failure, and surgical complications. A total of 24 adult patients were found to have retroperitoneal hematoma due to spontaneous lumbar artery rupture and were included in the study for further analysis. RESULTS: Male to female ratio was 14:10 and the mean age was 75.3+/-10.4 years old. Overall, 19 patients (79.1%) were taking warfarin, 20 patients (83.3%) were taking aspirin and/or clopidogrel, and 15 patients (62.5%) were taking both anticoagulant and antiplatelet medications. The most common presenting symptom was acute back pain. CT scan showed extravasation of contrast in 20 patients. The mean hematoma size was 12.5+/-6.4 cm. Eleven patients (55%) underwent arterial embolization and 22 patients (91.6%) received blood transfusion. No surgical intervention was performed. CONCLUSION: Retroperitoneal hematomas caused by spontaneous rupture of the lumbar artery showed a strong association with use of anticoagulant and/or antiplatelet therapy. For patients, particularly elderly patients, who present with acute back pain or hemodynamic instability and who are on anticoagulant and/or antiplatelet therapy, ER physicians should consider retroperitoneal hematoma as a differential diagnosis and to rule it out vigilantly.
Adult ; Aged ; Anticoagulants ; Arteries* ; Aspirin ; Back Pain ; Blood Transfusion ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Hematoma* ; Hemodynamics ; Hemorrhage ; Humans ; International Classification of Diseases ; Liver Cirrhosis ; Male ; Platelet Aggregation Inhibitors ; Renal Insufficiency ; Retroperitoneal Space ; Retrospective Studies* ; Rupture ; Rupture, Spontaneous* ; Tomography, X-Ray Computed ; Warfarin

We present a case of quadriceps tendon (QT) rupture. QT ruptures can occur in all ages. The cause is mostly traumatic in origin. Spontaneous ruptures that are thought to result from predisposing conditions are rare. Post-convulsion QT ruptures lacking traumas in their history can be overlooked in clinical examinations. This should be born in mind by the attending physician, as early diagnosis and treatment of the condition can lead to satisfactory outcomes.
Early Diagnosis ; Epilepsy ; Knee Joint ; Rupture ; Rupture, Spontaneous ; Seizures ; Tendon Injuries ; Tendons