The patient in this case continued to have recurrent pain and only transiently responded to fluid resuscitation; therefore, it was suspected that she had active bleeding. She was emergently transferred to the operating room for exploratory laparotomy and wedge resection of her hepatic tumor. Surgical resection was favored over TAE because of the peripheral location of the lesion. The patient was noted to have a small left lobe of the liver, and it was felt that she would not survive if a partial right hepatic lobectomy was performed.
Over 1 L of blood and clots were removed from the abdominal cavity. A visibly bleeding tumor was seen on the dome of the liver. Ultrasonography was used to check the margins of the tumor, and these margins were marked. A wedge resection was performed, and the major vessels were ligated. The patient received 2 units of packed red blood cells during the procedure and had an estimated blood loss of approximately 600 mL.
The tumor was sent to the pathology laboratory and was identified as HCC. The patient remained stable immediately after the procedure and was extubated in the intensive care unit. She was transfused with several units of packed red blood cells. Her hospital course was complicated by episodes of rapid atrial fibrillation, which responded to an intravenous diltiazem drip. She ultimately improved, with spontaneous resolution of her atrial fibrillation, and was discharged to home with instructions to follow up in both the general surgery and gastroenterology clinics.
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Cite this: James J. McCombie, Erik D. Schraga. A 61-Year-Old Woman With Abdominal Pain and Syncope - Medscape - Jun 01, 2016.