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December 1952

MASSIVE HEMORRHAGE FROM MALIGNANT HEPATOMAReport of a Case with Subsequent Transdiaphragmatic Resection

Author Affiliations

Dr. Roe is Assistant Clinical Professor of Surgery, University of California School of Medicine, San Francisco; formerly Resident Surgeon, Massachusetts General Hospital, Boston.

AMA Arch Surg. 1952;65(6):912-915. doi:10.1001/archsurg.1952.01260020906017

MASSIVE intraperitoneal hemorrhage from liver tumors has been reported previously. Thirteen cases have been found in the literature by Specter and Chodoff,1 including one of their own. The relative rarity of hepatoma in the Caucasian race and this unusual manifestation of it results in nearly every case in the diagnosis not being made until exploratory laparotomy or at autopsy. From the available information in the reported cases it is evident that very few of the patients reach the operating room in time for a successful outcome. Six patients died suddenly, and the diagnosis was established at autopsy; four patients underwent exploration but did not survive, and only three patients survived the initial episode, including Specter and Chodoff's patient who had had a resection at the initial operation.

Every surgeon is familiar with the clinical picture of acute peritoneal irritation produced by fresh intraperitoneal bleeding, but this situation is most

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