Life Saving Hepatic Resections in Ruptured Pediatric Hepatoblastoma - a Report of 3 Cases.

BACKGROUND: Hepatoblastoma is the most common primary malignant liver tumor in children, with peak incidence under three years of age. Tumor rupture, though rare, is a life-threatening complication that necessitates urgent intervention due to risks of hemorrhagic shock and peritoneal dissemination. This report highlights the clinical course, surgical management, and outcomes of three pediatric patients with ruptured hepatoblastoma. METHODS: We analyzed three cases of ruptured hepatoblastoma in children aged 1-2 years. Diagnosis was based on clinical presentation, imaging, serum alpha-fetoprotein (AFP) levels, and histopathology where required. Management strategies included neoadjuvant chemotherapy with the Super-PLADO regimen, transarterial chemoembolization (TACE) and emergency hepatic resections tailored to tumor extent and vascular involvement. RESULTS: All three patients presented with rupture either before or shortly after initiation of chemotherapy. One case involved a malignant rhabdoid variant with low AFP, necessitating biopsy for diagnosis. TACE was attempted in one case but surgical intervention was ultimately required in all due to worsening hemodynamic instability. Resections included left hepatectomy, non-anatomical segmental resection, and extended right hepatectomy. CONCLUSION: Ruptured hepatoblastoma is a surgical emergency requiring a multidisciplinary approach. Early recognition, stabilization, and timely surgical intervention are crucial for survival. Despite the high-risk nature of tumor rupture, favorable outcomes can be achieved with individualized, aggressive management combining surgery and other modalities.