Laparoscopic microwave ablation for the management of hemorrhage from ruptured hepatocellular carcinoma.

BACKGROUND

Treatment of ruptured hepatocellular carcinoma (HCC) focuses on hemorrhage control and utilizes tumor vascular anatomy to palliate or temporize selected patients with hepatic artery embolization (HAE). Radiofrequency ablation (RFA) and microwave ablation (MWA) are feasible alternatives or adjunct modalities to resection of HCC; the method of energy delivery in MWA allows uniform coagulative necrosis in shorter time compared with RFA.

CASE DESCRIPTION: We present the case of an 82-year-old man who presented with a ruptured liver tumor with active intraperitoneal bleeding on angiography. The patient remained hemodynamically stable with evidence of ongoing bleeding following HAE. Tumor destruction and definitive hemostasis were obtained with minimally invasive MWA.

CONCLUSION

Tumor rupture remains a negative prognostic factor in the course of HCC. In select patients, MWA allows definitive hemorrhage control with minimal surgical morbidity.  Hippokratia 2016, 20(2): 169-171.