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Abstract: A 55-year-old male patient with previous hepatitis B condition was admitted to the hospital for emergency resuscitation treatment because of sudden abdominal pain and hemorrhagic shock, which was found to be a ruptured liver tumor with hemorrhage.
Basic information】Male, 55 years old
Disease Type】Liver Tumor
Hospital】The First Hospital of Jilin University
Time】October 2021
Treatment plan] Interventional hepatic artery embolization + laparoscopic partial hepatectomy + fluorouracil intraperitoneal implantation
Treatment Period】Hospitalization for 10 days, regular review
Effectiveness】Condition is under control, anti-tumor treatment is in progress
I. Initial consultation
One winter night, I was out of the emergency room, and at about 3:00 in the second half of the night, a comatose patient came in with a white face, and I immediately sent the patient to the monitoring room for monitoring and oxygenation and rehydration. The patient’s family arrived at this time. The patient’s family said that the patient felt uncomfortable in the upper abdomen after a walk at around 4:00 p.m. today, and came home to the hospital after gradually experiencing abdominal pain on the bed, which was getting heavier and heavier. I also asked the patient’s past situation, the patient’s family said that the patient’s health is not bad, is a farmer, but has a hepatitis condition, because there are no obvious symptoms, there is no formal treatment, usually love to drink, can drink a pound to a pound and a half a day or so, the other is not special. I examined the patient and found a manifestation of abdominal distension, considering the possibility of intra-abdominal hemorrhage. I then performed a diagnostic laparotomy and found a hemorrhagic effusion. I explained to the family that the patient was very dangerous, and now was considering the possibility of hemorrhagic shock, which could be life-threatening at any time, and we immediately did the relevant tests.
II. Treatment process
The patient’s family agreed very much, and I prescribed a full abdominal enhancement CT, blood routine, liver function, and then gave symptomatic treatment with simultaneous rehydration and blood transfusion, the examination steps were carried out through the green channel of the hospital, so the speed was relatively fast. The nature of the liver tumor was considered malignant. I immediately explained to the patient’s family that the fastest way to stop the bleeding was to perform hepatic artery embolization under intervention and then to consider surgery to remove the tumor, and the patient’s family agreed. The patient’s family agreed. I immediately contacted the interventional surgeon for consultation and sent the patient to the catheterization laboratory through the green channel for interventional embolization treatment. After the patient’s condition stabilized, a laparoscopic partial hepatectomy was arranged for the patient, and the radical treatment of tumor was performed.
III. Treatment effect
The patient recovered relatively well after surgery. On the 3rd postoperative day, he developed abnormal liver function with transaminases up to 1500 U/L. We asked a hepatologist to come over for consultation and considered that it was acute liver function damage due to repeated surgery and bleeding, and gave symptomatic treatment to relieve the symptoms. The patient also did not have other complications such as bleeding and bile leakage, and resumed eating and getting out of bed on the 6th postoperative day, and was successfully discharged from the hospital around the 10th day. At the time of discharge, the pathological results were also released, and the patient was considered to have mixed hepatocellular carcinoma and bile duct cell carcinoma, which is a type of tumor with high malignancy.
IV. Notes
We are glad that the patient has brought his disease under control with this treatment, but the following matters should also be noted after discharge from the hospital.
1. pay close attention to abdominal symptoms, whether there is abdominal pain, fever, jaundice and other related manifestations to assess the postoperative recovery.
2. liver function, tumor markers and hepatobiliary and pancreatic enhanced CT related examinations should be performed regularly to clarify whether there is tumor recurrence and other conditions.
3. Patients should be treated with liver-protective drugs after surgery, and if hepatitis is found, antiviral treatment should be administered.
4. In terms of diet, high protein and high energy food should be the mainstay, and smoking and alcohol should be avoided.
V. Personal insight
There are many manifestations of liver tumor. If the tumor is exogenous in the liver, it may result in bleeding due to the rupture of peritoneum caused by the increase of tumor volume, which may lead to serious abdominal bleeding, resulting in hypotensive shock and life threatening in serious cases.
2. When liver tumor ruptures and bleeds, you should seek for medical treatment in time. After admission, you should try to replenish fluids and blood, and then hurry to improve relevant examinations and decide the next treatment and methods.
The most reasonable treatment for ruptured bleeding liver tumor is to rely on interventional treatment to stop bleeding, and then decide whether to perform radical surgery according to the situation, so as to save time and protect the life of patients.
4, the liver damage caused by the rupture and bleeding of the liver is relatively heavy, the patient may have liver insufficiency after surgery, close monitoring of liver function is needed, and if liver function abnormalities occur, liver failure also needs to be alerted. Therefore, postoperative conditioning and treatment are also very important.