Successful liver resection in a giant hemangioma with intestinal obstruction after embolization

Abstract

Hepatic hemangiomas are the most common benign tumor of the liver. Most hepatic hemangiomas remain asymptomatic and require no treatment. Giant hepatic hemangiomas with established complications, diagnostic uncertainty and incapacitating symptoms, however, are generally considered an absolute indication for surgical resection. We present a case of a giant hemangioma with intestinal obstruction following transcatheter arterial embolization, by which the volume of the hemangioma was significantly reduced, and it was completely resected by a left hepatectomy. A 21-year-old Asian man visited our hospital for left upper quadrant pain. Examinations at the first visit revealed a left liver hemangioma occupying the abdominal cavity, with a maximum diameter of 31.5 cm. Embolization of the left hepatic artery was performed and confirmed a decrease in its size. However, the patient was readmitted to our hospital one month after embolization for intestinal obstruction. A left hepatectomy was completed through a herringbone incision, and safely removed a giant hemangioma of 26.5 cm × 19.5 cm × 12.0 cm in size and 3690 g in weight. Pre-operative arterial embolization is effective for reducing tumor size, but a close follow-up to decide the time for hepatectomy is important.

Keywords: Complications; Hepatectomy; Hepatic hemangioma; Intestinal obstruction; Transcatheter arterial embolization.

Figure 1

Axial images of multi-detector computed tomography. Multi-detector computed tomography (MDCT) images at the first visit (A-C), and corresponding MDCT slices just before the operation (i.e., one month after transcatheter arterial embolization) (E-G).

Figure 2

Coronal (A) and sagittal (B) views of the hemangioma from magnetic resonance imaging.

Figure 3

Intra-operative photograph of the tumor.