Case report: Haemoperitoneum secondary to acute rupture of primary hepatic angiosarcoma

Boyoung Kim; Rebecca Reardon; Jane Cross; Trafford Fehlberg; Benjamin Allanson; Gratian J Punch

doi:10.1016/j.ijscr.2021.106090

Case report: Haemoperitoneum secondary to acute rupture of primary hepatic angiosarcoma

Int J Surg Case Rep. 2021 Jul:84:106090. doi: 10.1016/j.ijscr.2021.106090. Epub 2021 Jun 10.

Authors

Boyoung Kim¹, Rebecca Reardon², Jane Cross², Trafford Fehlberg², Benjamin Allanson³, Gratian J Punch²

Affiliations

¹ Department of General Surgery, Lismore Base Hospital, 60 Uralba Street, Lismore NSW 2480, Australia. Electronic address: boyoungkim31@gmail.com.
² Department of General Surgery, Lismore Base Hospital, 60 Uralba Street, Lismore NSW 2480, Australia.
³ Department of Pathology, Lismore Base Hospital, 60 Uralba Street, Lismore NSW 2480, Australia.

Abstract

Introduction and importance: Primary hepatic angiosarcoma (PHA) is a rare and aggressive liver malignancy of endothelial cell origin and is associated with poor outcome. Pre-operative confirmation of the diagnosis is challenging, as clinical and radiological findings are generally non-specific. Very rarely, spontaneous haemoperitoneum may occur due to the spontaneous rupture of previously undiagnosed PHA.

Case presentation: We describe a case of a 28-year-old male with haemoperitoneum due to the rupture of previously undiagnosed PHA. After failing to respond to the non-operative measures, the patient underwent emergency partial liver resection and recovered without any post-operative complications. Histopathological examination of the specimen confirmed the diagnosis of PHA. Two months after the operation, the patient represented with advanced metastatic disease and disseminated intravascular coagulation (DIC). The patient died one month after discharge.

Clinical discussion: A patient with PHA presents a diagnostic challenge due to its rare incidence and non-specific clinical findings. Spontaneous intra-abdominal haemorrhage can occur due to PHA rupture and carries a dismal prognosis. In addition to emergency haemorrhage control, complete surgical resection with clear margins is the definitive treatment to date, however, most cases of PHA are unresectable at diagnosis and recurrence is common even after complete resection.

Conclusion: PHA is associated with very poor outcomes, due to its rapid progression, early recurrence, and metastatic nature. The median survival is approximately 5 months. Haemoperitoneum secondary to rupture of previously undiagnosed PHA is uncommon and is a poor prognostic indicator. Complete surgical resection of the disease is challenging and there is no established treatment.

Keywords: Case report; Haemoperitoneum; Hepatectomy; Primary hepatic angiosarcoma.