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Torsion of a giant pedunculated liver hemangioma mimicking acute appendicitis: a case report.

Ersoz F, Ozcan O, Toros AB, Culcu S, Bektas H, Sari S, Pasaoglu E, Arikan S - World J Emerg Surg (2010)

Bottom Line: Most cases are asymptomatic and do not require any treatment.If they undergo torsion and infarction, they become symptomatic.At laparotomy a normal appendix was observed and a torsioned pedinculated liver hemangioma turned out to be the cause.

View Article: PubMed Central - HTML - PubMed

Affiliation: Istanbul Education and Research Hospital, Department of General Surgery, Istanbul, Turkey.

ABSTRACT
Hemangiomas are the most common benign neoplasms affecting the liver. They occur at all ages. Most cases are asymptomatic and do not require any treatment. Rarely, hemangiomas can be pedunculated. If they undergo torsion and infarction, they become symptomatic. Herein; we report the case of a 31 year old male presenting with features of acute appendicitis: continuous right iliac fossa pain, rebound, guarding tenderness at McBurney' s point, nausea, anorexia, shifted white blood cell count and a Mantrels score of 6. At laparotomy a normal appendix was observed and a torsioned pedinculated liver hemangioma turned out to be the cause.

No MeSH data available.


Related in: MedlinePlus

Pedinculated hemangioma on the operation table; black arrow points the pedincule.
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Figure 1: Pedinculated hemangioma on the operation table; black arrow points the pedincule.

Mentions: A 31 year old man admitted to our emergency department with a 2 day history of right iliac fossa pain which he described as continuous. He also had anorexia, nausea. On physical examination, his pulse rate was 96 beats/min, his body temperature was 37.1°C. His abdomen was markedly tender at the right iliac fossa with guarding and rebound tenderness at McBurney's point. The rest of the systemic examination was normal and the Mantrels score of the patient was 6. Laboratory data was as follows; hemoglobin 15.8 g/dl, total leukocyte count 9700/mm3, with 75% polymorphonuclear leukocytes, 37% lymphocytes, 3,2% monocytes, and 1% eosinophils; erythrocyte sedimentation rate was 2 mm for 1 h. Liver function tests, serum electrolytes, and creatinine were all within normal ranges. His bowel movements were regular on oscultation. Per rectum examination was normal. The abdominal X-ray was normal and because of the manifest clinical picture, abdominal ultrasound was not performed. Under the light of medical history and signs on abdominal examination, the patient was diagnosed as having acute appendicitis with a Mantrels score of 6 and was taken to theatre for appendectomy. At operation a normal appendix was found. At further exploration, a large soft reddish mass was palpated near the caecum. Macroscopically, the mass measured 10 × 12 × 15 cm. It was connected to the right inferior margin of the liver with a thin pedincule. It had undergone a 360° clockwise torsion on its pedincule. The mass was easily detorsioned and resected (Fig 1 and 2). Appendectomy was also performed using the routine method. Histologic assessment confirmed a cavernous hemangioma. The mass had multiple vascular spaces and fibrosis and was unusual for that there was a considerable amount of adipocytes intermingling within the tumor (Fig 3). The patient's recovery was uneventful, and he was discharged on the 2nd postoperative day.


Torsion of a giant pedunculated liver hemangioma mimicking acute appendicitis: a case report.

Ersoz F, Ozcan O, Toros AB, Culcu S, Bektas H, Sari S, Pasaoglu E, Arikan S - World J Emerg Surg (2010)

Pedinculated hemangioma on the operation table; black arrow points the pedincule.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2820011&req=5

Figure 1: Pedinculated hemangioma on the operation table; black arrow points the pedincule.
Mentions: A 31 year old man admitted to our emergency department with a 2 day history of right iliac fossa pain which he described as continuous. He also had anorexia, nausea. On physical examination, his pulse rate was 96 beats/min, his body temperature was 37.1°C. His abdomen was markedly tender at the right iliac fossa with guarding and rebound tenderness at McBurney's point. The rest of the systemic examination was normal and the Mantrels score of the patient was 6. Laboratory data was as follows; hemoglobin 15.8 g/dl, total leukocyte count 9700/mm3, with 75% polymorphonuclear leukocytes, 37% lymphocytes, 3,2% monocytes, and 1% eosinophils; erythrocyte sedimentation rate was 2 mm for 1 h. Liver function tests, serum electrolytes, and creatinine were all within normal ranges. His bowel movements were regular on oscultation. Per rectum examination was normal. The abdominal X-ray was normal and because of the manifest clinical picture, abdominal ultrasound was not performed. Under the light of medical history and signs on abdominal examination, the patient was diagnosed as having acute appendicitis with a Mantrels score of 6 and was taken to theatre for appendectomy. At operation a normal appendix was found. At further exploration, a large soft reddish mass was palpated near the caecum. Macroscopically, the mass measured 10 × 12 × 15 cm. It was connected to the right inferior margin of the liver with a thin pedincule. It had undergone a 360° clockwise torsion on its pedincule. The mass was easily detorsioned and resected (Fig 1 and 2). Appendectomy was also performed using the routine method. Histologic assessment confirmed a cavernous hemangioma. The mass had multiple vascular spaces and fibrosis and was unusual for that there was a considerable amount of adipocytes intermingling within the tumor (Fig 3). The patient's recovery was uneventful, and he was discharged on the 2nd postoperative day.

Bottom Line: Most cases are asymptomatic and do not require any treatment.If they undergo torsion and infarction, they become symptomatic.At laparotomy a normal appendix was observed and a torsioned pedinculated liver hemangioma turned out to be the cause.

View Article: PubMed Central - HTML - PubMed

Affiliation: Istanbul Education and Research Hospital, Department of General Surgery, Istanbul, Turkey.

ABSTRACT
Hemangiomas are the most common benign neoplasms affecting the liver. They occur at all ages. Most cases are asymptomatic and do not require any treatment. Rarely, hemangiomas can be pedunculated. If they undergo torsion and infarction, they become symptomatic. Herein; we report the case of a 31 year old male presenting with features of acute appendicitis: continuous right iliac fossa pain, rebound, guarding tenderness at McBurney' s point, nausea, anorexia, shifted white blood cell count and a Mantrels score of 6. At laparotomy a normal appendix was observed and a torsioned pedinculated liver hemangioma turned out to be the cause.

No MeSH data available.


Related in: MedlinePlus