From an Incidental Finding to an Emergent Treatment: A Case Report of a Hepatic Adenomatosis and Large Ruptured Hepatic Adenoma

Abstract

Introduction. Hepatic adenoma is an uncommon benign liver tumor presenting as solitary lesions or even rarely as hepatic adenomatosis. Large lesions carry a risk of rupture, hemorrhage, and malignant transformation. This case report aims to increase awareness about risk factors for hepatic adenomas, considering the increasing prevalence of obesity and the widespread use of oral contraceptive pills. Case Presentation. A 20-year-old obese female who was taking oral contraceptive pills for seven years presented to the emergency department with vomiting and abdominal pain caused by gastroenteritis. On imaging, multiple hepatic adenomas, including two lesions 6 and 9 cm in diameter, were incidentally found. During the hospitalization, the patient suddenly developed acute anemia and rupture of the largest lesion, which was promptly treated with arterial embolization. Discussion. Obesity and exposure to hormones are well-known risk factors for hepatic adenomas. The incidence of hepatic adenomas is steadily increasing because of the prevalence of obesity, especially among females. Lifestyle interventions for weight loss and discontinuation of oral contraceptive pills are considered a conservative treatment of hepatic adenomas. Large lesions possess the risk of malignant transformation and rupture and require surgical excision.

Figure 1

MRI of the liver with contrast showing a sizable hemorrhagic HA measuring 9.0 × 8.5 cm and adjacent nonhemorrhagic HA 5.9 × 5.1 cm (segment 4) and several HAs smaller than 5 cm in diameter.

Figure 2

(a) Subselective catheterization of the hepatic artery, segment 8 branch with arteriography. (b) Cone beam CT demonstrating patency and perfusion of the hepatic adenoma. (c) Coil embolization of segment 8 branch of the hepatic artery.

Figure 3

CT scan of the abdomen performed the next day after embolization showing the decrease in the dominant lesion size to 8.0 × 7.9 cm.

Figure 4

CT scan of the abdomen repeated in two months showing that the dominant HA decreased in size, measuring 7.1 × 5.7 cm, with coils and a resolved hemorrhagic component. The nonhemorrhagic mass in segment four decreased to 4.2 cm in diameter.