Spontaneous intra-abdominal hematomas in a hepatocellular carcinoma patient treated with lenvatinib: a case report

A 44-year-old patient was admitted with tumor rupture in the left hepatic lateral lobe, and he underwent emergent exploratory laparotomy and proceeded for hepatic left lateral lobectomy on September 19, 2021. The final diagnosis of hepatocellular carcinoma was confirmed by histopathological examination of the surgical specimen. Afterward, the patient received hepatic arterial infusion chemotherapy with FOLFOX(oxaliplatin, fluorouracil, and leucovorin) for 5 cycles. Subsequently, recurrence of the hepatocellular carcinoma was diagnosed in the abdominal cavity. The patient was then treated with lenvatinib. Within less than 1 month of the treatment with lenvatinib, the patient was admitted to the emergency room on June 2, 2022, because of acute intra-abdominal bleeding(hematomas). Percutaneous intra-abdominal angiography found that the bleeding vessels were the right gastroepiploic artery and left gastric artery. The patient was stabilized after arterial embolization using gelatin sponges. The diagnosis and management of spontaneous intra-abdominal hematomas are discussed.