Journal of the Chinese Medical Association
Volume 70, Issue 3 , Pages 126-131, March 2007

Treatment of Massive Retroperitoneal Hemorrhage from Adrenal Metastasis of Hepatoma

  • Por-Wen Yang

      Affiliations

    • Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taipei, Taiwan, R.O.C.
    • ,
  • Wen-Yen Wang

      Affiliations

    • Department of Surgery, Hsinchu General Hospital, Hsinchu, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Wen-Yen Wang, Department of Surgery, Hsinchu General Hospital, Department of Health, The Executive Yuan, No. 25, Lane 442, Section 1, Jingguo Road, Hsinchu City 300, Taiwan, R.O.C.
    • ,
  • Chin-Hua Yang

      Affiliations

    • Department of Radiology, Taoyuan General Hospital, Taoyuan, Taipei, Taiwan, R.O.C.
    • ,
  • Chia-Cheng Chou

      Affiliations

    • Department of Surgery, Taoyuan General Hospital, Taoyuan, Taipei, Taiwan, R.O.C.
    • ,
  • David Hung-Tsang Yen

      Affiliations

    • Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Jason Chou

      Affiliations

    • Department of Pathology, Taoyuan General Hospital, Taoyuan, Taipei, Taiwan, R.O.C.

Received 4 July 2006; accepted 3 January 2007.

Article Outline

Spontaneous rupture of metastatic adrenal tumor with massive retroperitoneal hemorrhage and shock is an uncommon clinical event. Herein, we report a case of hepatocellular carcinoma (HCC), where left hepatic lobectomy and right adrena-lectomy for metastatic HCC were performed in April and August 2002, respectively. Subsequently, the patient presented to the emergency room with acute-onset severe left flank and back pain in March 2004, accompanied by a falling hemoglobin level. Computed tomography revealed a 7-cm left adrenal tumor mass with retroperitoneal hemorrhage. The ruptured adrenal tumor was further confirmed by selective angiography, which demonstrated that the bleeder was supplied by the left suprarenal artery. Transarterial embolization (TAE) to stop tumor bleeding was performed successfully. The patient then underwent tumor resection with left adrenalectomy 5 days after the embolization, with pathology subsequently revealing metastatic HCC. The recurrent intrahepatic HCC was controlled with TAE, and the patient underwent hormone replacement therapy with prednisolone 10 mg/day. Metastatic adrenal tumor bleeding should be suspected in hepatoma patients who suffer abrupt flank pain and shock. Hemodynamically unstable patients require supportive transfusions and urgent surgical exploration. Angiographic embolization, if deemed feasible, may be a valuable adjunct for achievement of hemostasis prior to definite surgery.

Key Words:  adrenal tumor , embolization , hepatocellular carcinoma , metastasis

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PII: S1726-4901(09)70343-0

doi:10.1016/S1726-4901(09)70343-0

Journal of the Chinese Medical Association
Volume 70, Issue 3 , Pages 126-131, March 2007

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