Haemostatic treatment of a bleeding hepatocarcinoma by polypropylene mesh wrapping in a cirrhotic patient.

Spontaneous rupture of hepatocarcinoma (HCC) in a cirrhotic patient is a serious complication with a high incidence of mortality. The pathogenesis of this complication is unknown. Several hypotheses have been proposed in the literature worldwide. The diagnosis, in the absence of specific symptoms, is made by ultrasound, sometimes followed by a CT scan, and finally by exploratory paracentesis. An angiogram is performed to locate the site of the bleeding and possibly allow transcatheter arterial chemo-embolisation. Therapeutic options include one-stage or delayed resection, packing for sub-diaphragmatic bleeding HCC's, and hepatic artery ligation. Suture ligation of the bleeding source is usually impossible due to the friability of the tumor. No sizeable experience with the use of alcoholisation for haemostasis has been reported to date. We report a case of HCC bleeding from segment VI successfully treated by manual compression and placement of a polypropylene mesh (Biomesh P1, Cousin Biotech).