Article Text

Download PDFPDF
Unusual cause of intraoperative haemorrhage: a lesson for patient counselling
  1. Laith Omar Khalaf Alghazawi,
  2. Olivia Holtermann Entwistle,
  3. Matyas Fehervari and
  4. Duncan Spalding
  1. HPB Surgery, Imperial College Healthcare NHS Trust and Imperial College London, London, UK
  1. Correspondence to Mr Duncan Spalding; d.spalding{at}


Hepatocellular carcinoma (HCC) is a well-known malignant neoplasm of the liver associated with spontaneous haemorrhage in 3%–15% of cases. This complication is life threatening and has a mortality rate of 33%–100%. Despite the frequency and severity of spontaneous haemorrhage, the importance of patient education about this complication has not been highlighted before. There is currently no information available on the NHS UK website, and no publications have addressed the effect of patient education. We present this case report describing a patient who developed classical symptoms of haemorrhage the day before her elective HCC resection, but was unaware of its importance, and thus did not seek medical attention. She was subsequently found to have a large volume haemoperitoneum, anaemia and a ruptured HCC intraoperatively. This case illustrates the significant importance of counselled regarding the symptoms and risk of spontaneous rupture of HCC to prompt early presentation to medical services.

  • Surgical oncology
  • Hepatic cancer

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All authors have contributed to the planning, conduct and reporting of the work described in the article.Main contributors of project idea and design are DS and MF. Literature review and data collection were mainly contributed by LA and OE. Design framework by DS and MF. Overview of literature review and abstract are DS and MF.Analysis and learning points contributed by LA,OE,MF and DS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.