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Case Reports
. 2010 Apr-Jun;16(2):116-9.
doi: 10.4103/1319-3767.61240.

Spontaneous rupture of a giant hepatic hemangioma - sequential management with transcatheter arterial embolization and resection

Vaibhav Jain  1 , Vijay Ramachandran, Rachana Garg, Sujoy Pal, Shivanand R Gamanagatti, Deep N Srivastava
Affiliations
Case Reports

Spontaneous rupture of a giant hepatic hemangioma - sequential management with transcatheter arterial embolization and resection

Vaibhav Jain et al. Saudi J Gastroenterol. 2010 Apr-Jun.

Abstract

Hemangioma is the most common benign tumor of liver and is often asymptomatic. Spontaneous rupture is rare but has a catastrophic outcome if not promptly managed. Emergent hepatic resection has been the treatment of choice but has high operative mortality. Preoperative transcatheter arterial embolization (TAE) can significantly improve outcome in such patients. We report a case of spontaneous rupture of giant hepatic hemangioma that presented with abdominal pain and shock due to hemoperitoneum. Patient was successfully managed by TAE, followed by tumor resection. TAE is an effective procedure in symptomatic hemangiomas, and should be considered in such high risk patients prior to surgery.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Axial CECT images of liver (a–d) show a mass in segments 6 and 7 with peripheral nodular enhancement suggestive of a hemangioma. Note a rent on the postero-superior aspect of the tumor (arrows), indicating focal rupture. High density peritoneal fluid is seen in perihepatic region (asterisk)
Figure 2
Figure 2
Delayed CT image (a) shows progressive centripetal filling-in of the tumor with contrast, confirming the diagnosis of a hemangioma, with a central non-enhancing area (arrow) suggestive of a fibrotic scar. Pack of sponges from the previous surgery (asterisk) can be seen at the liver surface. In addition, hyperdensity seen along the liver surface (solid arrows-b) represents active contrast extravasation
Figure 3
Figure 3
(a) Celiac angiogram showing extravasation of contrast from the region of right lobe of liver (arrow). Selective angiogram of right hepatic artery, immediate (b) and delayed (c) images, show characteristic pooling and puddling of contrast in the liver hemangioma as well as the active arterial extravasation (solid arrow). (d) Post embolization angiogram confirms lack of any active contrast extravasation. The steel coils can be seen as filling defects within the principal feeding arteries (arrows).
Figure 4
Figure 4
Peroperative photograph showing the mobilized liver with the hemangioma seen involving the segments VI and VII (asterisk)
See this image and copyright information in PMC

References

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