Spontaneous Rupture of Hepatic Metastasis fromPancreatic Adenocarcinoma

A 58-year-old man with advanced-stage pancreatic adenocarcinoma presented with fatigue and dyspnea. Examination revealedtachycardia (102 b/min) with mild tenderness in right upper quadrant. His hemoglobin (Hb) was 7.9 g/dL (10 days prior topresentation 12.2 g/dL), International normalized ratio (INR), platelet count was normal, and the stool guaiac test was negative.On admission, abdominal computed tomography (CT) scan showed hepatic metastatic lesion with a rupture and hemoperitoneumcommunicating to the subdiaphragmatic space. This rapid progression of anemia along with presenting symptoms and CT imagingwere attributed to diagnosis of spontaneous rupture of liver metastasis from pancreatic adenocarcinoma. Patient received bloodtransfusion and hemoglobin was monitored in successive intervals. His general condition and anemia improved with conservativemanagement and he was discharged in 3 days. Repeated CT after 4 months showed resolving hemoperitoneum and stablehemoglobin levels. The patient deceased 9 months after being diagnosed. A literature search revealed limited data regarding theincidence and management of spontaneous rupture of metastatic lesion secondary to pancreatic adenocarcinoma which has beenmanaged conservatively and thus we are reporting our experience.