Spontaneous rupture of pyogenic liver abscess with subcapsular hemorrhage mimicking ruptured hepatocellular carcinoma: A case report

Preoperative Transcatheter Arterial Embolization for Spontaneous Rupture of Huge Amebic Liver Abscess with Massive Intraperitoneal Hemorrhage

An 18-year-old male developed a huge liver abscess with severe anemia over the course of 2 weeks. Abdominal contrast enhanced computed tomography showed ruptured huge liver abscess in the right liver lobe with signs of active hemorrhage (contrast extravasation). Serology examination confirmed amoeba as the suspected pathogen of cause. Angiography was performed followed by transcatheter arterial embolization to localize and control the hemorrhage. Embolization using a combination of polyvinyl alcohol and gelfoam successfully controlled the active hemorrhage. Exploratory laparotomy was performed to evacuate and debride the huge abscess. Metronidazole was given and showed good results. Huge liver abscess size is a predictor of conservative management failure and requires a gradual step-up intervention. The purpose of this paper is to explain the importance of imaging in detecting liver abscess and active hemorrhage along with the role of interventional radiology in this case.

Case report: Urgent liver pathologies: All in one

Ruptured hepatocellular carcinoma (HCC) is a well-known serious complication of this most common primary liver malignancy. However, when HCC rupture is associated with other focal liver lesions, the diagnosis and therapy may be very challenging. Correct differentiation of focal liver lesions is of paramount importance for successful treatment. The aim of this report is to present a unique case of HCC rupture complicated with liver abscess, hematoma and portal vein thrombosis. We discuss possible pathophysiological mechanisms and radiologic findings of such clinical scenarios and review literature related to the management of HCC rupture.

Emergency Nursing Countermeasures and Experience of Patients with Primary Liver Cancer Nodule Rupture and Hemorrhage

Objective

To explore the emergency nursing countermeasures and nursing experience of patients with primary liver cancer nodule rupture and hemorrhage.

Methods

30 patients with primary liver cancer nodule rupture and hemorrhage treated in our hospital since January 2020 after the implementation of emergency nursing countermeasures were selected as the observation group, and another 30 patients with primary liver cancer nodule rupture and hemorrhage treated in our hospital before January 2020 were selected as the control group. The control group received basic nursing intervention, while the observation group received emergency nursing measures. The hemoglobin level, blood oxygen saturation monitoring value, and partial pressure of oxygen of patients with hemorrhagic shock due to nodular rupture of primary liver cancer were compared between the two groups at admission and after nursing care. All indexes of patients during the perioperative period were recorded. The incidence of complications, mortality, and nursing satisfaction rates of the patients' families were compared between the two groups.

Results

After nursing care, the observation group's patients' hemoglobin level, blood oxygen saturation monitoring value, and partial pressure of oxygen were higher than those of the control group's patients (P < 0.05). The intraoperative bleeding volume, shock correction time, and discharge time of patients in the observation group were lower than those of patients in the control group (P < 0.05). The incidence of complications and mortality in the observation group was significantly lower than those in the control group (P < 0.05). The nursing satisfaction rate of patients in the observation group was higher than that of the control group (P < 0.05).

Conclusion

The results of emergency nursing intervention in patients with primary liver cancer rupture and hemorrhage are reliable, which can significantly improve perioperative indicators of patients, reduce complications and mortality, improve nursing satisfaction, and effectively shorten the hospital stay of patients.

Short-Term and Long-Term Curative Effect of Partial Hepatectomy on Ruptured Hemorrhage of Primary Liver Cancer after TAE

Objective

To observe the short-term and long-term curative effects of partial hepatectomy on ruptured hemorrhage of primary liver cancer after transcatheter arterial embolization (TAE).

Methods

A total of 150 patients with primary liver cancer treated in the hospital were enrolled as research objects between February 2018 and February 2021, including 75 cases undergoing TAE in the TAE group and the other 75 cases undergoing elective partial hepatectomy after TAE in the combination group. The surgical related indexes (leaving bed time, discharge time, success rate of hemostasis, lesion clearance rate), mean arterial pressure (MAP), heart rate (HR), hemoglobin, and liver function indexes (serum alpha-fetoprotein (AFP), albumin (ALB), total bilirubin (TBIL)) before and after treatment, postoperative complications, survival rate, and recurrence rate at 1 year after surgery between the two groups were compared.

Results

Compared with the TAE group, hospitalization time was shorter (P < 0.05), the success rate of hemostasis and lesions clearance rate were higher in the combination group (P < 0.05). After surgery, levels of HR and serum AFP were significantly decreased, while levels of MAP, hemoglobin, serum ALB, and TBIL were significantly increased in both groups. The levels of HR and serum AFP in the combination group were lower than those in the TAE group, while levels of MAP, hemoglobin, serum ALB, and TBIL were higher than those in the TAE group (P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P < 0.05). Compared with the TAE group, the recurrence rate was lower, and the survival rate was higher in the combination group at 1 year after surgery (P < 0.05).

Conclusion

Partial hepatectomy can effectively improve hemostatic effect and liver function in ruptured hemorrhage of primary liver cancer after TAE, increase survival rate, and reduce postoperative recurrence rate.