SFGH 11.30 pearls: HCC and abdominal perforation

  • Nearly 80% of HCC cases are due to HBV or HCV infection. While HCC can develop in HBV infection without cirrhosis, 70-90% of patients with HBV and HCC do have cirrhosis
  • Cutaneous metastases of HCC are extremely rare and have no classic characteristics, but have been described in multiple case reports.
  • CT is the most high yield imaging study with very high sensitivity and specificity for extraluminal air and the location of the source can sometimes be identified (though not always, as in this case)
    • Plains films are 50-70% sensitive for detecting free air and usually cannot localize the source of the perforation if free air is seen
  • In general, any patient with abdominal pain and free air on imaging should be taken emergently for surgical exploration
    • In patients with Childs-Pugh C liver disease, intra-abdominal surgery is associated with a mortality rate around 60%
  • Even without signs or symptoms of infection, broad spectrum antibiotics should be initiated if perforation is known/suspected

Evernote link: https://www.evernote.com/shard/s300/sh/03355e8d-af39-4a9f-b1c5-c9d0c5fbb1c9/c8f23218a218fb8a93c494ddcf46ebb5

Ghahremani GG. Radiologic evaluation of suspected gastrointestinal perforations. Radiol Clin North Am 1993; 31:1219.

Perz JF, Armstrong GL, Farrington LA, et al. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006; 45:529.

Lazaro M et al. Cutaneous metastases of hepatocellular carcinoma. Clin Exp Dermatol. 209 Dec;34(8)e567-9.

Telem DA, Schiano T, Goldstone R, et al. Factors that predict outcome of abdominal operations in patients with advanced cirrhosis. Clin Gastroenterol Hepatol 2010; 8:451.

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