Case Report
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World J Gastroenterol. Jan 21, 2013; 19(3): 418-421
Published online Jan 21, 2013. doi: 10.3748/wjg.v19.i3.418
Emergency caudate lobectomy for ruptured hepatocellular carcinoma with multiple primary cancers
Long-Hao Sun, Hong-Qiu Han, Peng-Zhi Wang, Wei-Jun Tian
Long-Hao Sun, Hong-Qiu Han, Peng-Zhi Wang, Wei-Jun Tian, Department of General Sugery, Tianjin Medical University General Hospital, Tianjin 300052, China
Author contributions: Han HQ and Tian WJ performed the operation; Sun LH and Wang PZ collected case data; Sun LH and Tian WJ wrote the paper.
Correspondence to: Wei-Jun Tian, Professor, Department of General Sugery, Tianjin Medical University General Hospital, Tianjin 300052, China. jonathontian@163.com
Telephone: +86-22-60362365 Fax: +86-22-60362365
Received: November 2, 2012
Revised: December 17, 2012
Accepted: December 22, 2012
Published online: January 21, 2013
Processing time: 80 Days and 3.8 Hours
Abstract

We report a case of metachronous multiple primary malignancies involving both rectum and liver with colonic metastasis from hepatocellular carcinoma (HCC) through hematogenous pathway. A 72-year-old woman was admitted to the emergency department with right upper abdominal pain for 4 h. Considering her surgical history of Mile’s procedure plus liver resection for rectal cancer with liver metastasis three years ago and the finding of urgent computed tomography scan on admission, the preoperative diagnosis was spontaneous rupture of rectal liver metastasis located in caudate lobe and colonic metastasis from rectal cancer. The patient underwent an emergency isolated caudate lobectomy at a hemorrhagic shock status. Pathology reported a primary HCC in the caudate lobe and colonic metastasis of HCC with tumor embolus in the surrounding vessels of the intestine. No regional lymph node involvement was found. It is hypothesized that HCC may disseminate hematogenously to the ascending colon, thus making it a rare case.

Keywords: Emergency isolated caudate lobectomy; Multiple primary malignancies; Rectal adenocarcinoma; Hepatocellular carcinoma; Hematogenous metastasis