Pop goes the tumour! Spontaneous haemorrhage of a hepatocellular carcinoma tumour

Agostinho, Nelson; Bains, Harinder K; Douglas, Cameron P; Walcott, James; Brown, Kilian G M; Rawson, Robert; Sandroussi, Charbel; Perera, Meegodage Ruwan Suramal

An 84-year-old man presented to a rural hospital in Australia with haemodynamic instability and abdominal pain. Investigation revealed haemorrhage from a lesion in his liver—an incidental finding of a hepatocellular carcinoma. Initial resuscitation and damage control surgery was performed at the peripheral hospital prior to transfer to a tertiary centre 386 km away for the second stage of management. The second stage of management included interventional radiological embolization of the bleeding liver vessel and subsequent resection of the liver tumour. This was all undertaken with new policies in place to limit the spread of infection at the peak of the COVID-19 epidemic.