Korean J Leg Med.  2013 Feb;37(1):42-45. 10.7580/kjlm.2013.37.1.42.

Death by Spontaneous Hemoperitoneum due to the Rupture of Capsular Vasculature in Hepatocellular Carcinoma Patient: A Case Report

Affiliations
  • 1Division of Forensic Medicine, National Forensic Service, Seoul, Korea. ecc88@korea.kr

Abstract

Hepatocellular carcinoma (HCC) is one of the leading causes of death in Korea. Chronic hepatitis, alcoholic liver disease and liver cirrhosis are predisposing factor of HCC. Bleeding tendency and hemorrhage resulting from reduced production of coagulation factors or portal hypertension are not uncommon in HCC, moreover spontaneous hemoperitoneum also can occur. Spontaneous hemoperitoneum is a complication of HCC, that is caused by the rupture of HCC mass which abuts on the hepatic capsule. However hemoperitoneum also occurs due to the rupture of vasculature of the mass. Emergency laparotomy is the recommended treatment, however these patients exhibit poor prognosis because of hemodynamic instability followed by combined liver disease. Herein, we report a case of spontaneous hemoperitoneum due to the rupture of subcapsular vessels with invasion of HCC in a 39-years-old man, whose tumor was left undetected.

Keyword

Unexpected death; Hepatocellular carcinoma; Spontaneous hemoperitoneum

MeSH Terms

Blood Coagulation Factors
Carcinoma, Hepatocellular
Cause of Death
Emergencies
Hemodynamics
Hemoperitoneum
Hemorrhage
Hepatitis, Chronic
Humans
Hypertension, Portal
Korea
Laparotomy
Liver Cirrhosis
Liver Diseases
Liver Diseases, Alcoholic
Prognosis
Rupture
Blood Coagulation Factors

Figure

  • Fig. 1. A volcano-shaped ruptured vascular lesion is seen on the right lobe of liver.

  • Fig. 2. The cut section shows a well demarcated mass without any capsule.

  • Fig. 3. The ruptured vascular lesion, which is restricted on the surface, lies above the hepatic mass.

  • Fig. 4. The ruptured vascular lesion consists delicate small vascular channels filled with blood, and invaded by hepatocellular carcinoma.


Reference

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