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Enucleation after Embolization of Liver Failure-Causing Giant Liver Hemangioma.

Sharma A, Kaspar M, Siddiqui M, Kim J - Am J Case Rep (2015)

Bottom Line: While typically benign, these tumors can occasionally grow to sufficient size to cause a number of symptoms, including pain, severe hepatic dysfunction, or, rarely, consumptive coagulopathy.In such instances, surgical treatment may be warranted.Early referral to experienced surgical centers before the onset of dire complications such as severe hepatic dysfunction and liver failure is recommended.

View Article: PubMed Central - PubMed

Affiliation: Division of Transplantation Surgery, Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA.

ABSTRACT

Background: Hepatic hemangioma is a congenital tumor of the mesenchymal tissues of the liver. While typically benign, these tumors can occasionally grow to sufficient size to cause a number of symptoms, including pain, severe hepatic dysfunction, or, rarely, consumptive coagulopathy. In such instances, surgical treatment may be warranted.

Case report: We present a case of a symptomatic giant hepatic hemangioma in an elderly patient who presented with impending liver failure. She was successfully treated with a combination of surgical enucleation and liver resection after preoperative arterial embolization. We also provide a brief discussion of current treatment options for giant hepatic hemangiomas.

Conclusions: Early referral to experienced surgical centers before the onset of dire complications such as severe hepatic dysfunction and liver failure is recommended.

No MeSH data available.


Related in: MedlinePlus

Pre-operative hepatic angiography. The left hepatic artery feeding the massive hemagioma was embolized successfully to achieve reduction in tumor size.
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f3-amjcaserep-16-563: Pre-operative hepatic angiography. The left hepatic artery feeding the massive hemagioma was embolized successfully to achieve reduction in tumor size.

Mentions: The patient underwent hepatic angiography (Figure 3) prior to the planned resection. An uncomplicated partial embolization of the giant hemangioma via the left hepatic artery using 2 vials of 500–700 micron diameter embospheres was performed. Two days later she was taken to the operating room. Our liver transplant team, including an anesthesiologist and support staff, participated in this surgery. Provisions were made for backbench ex vivo perfusion of the liver, if required. A massive transfusion protocol was set-up and a veno-venous bypass team was placed on standby. Surgical exposure of the giant hemangioma was obtained via a midline incision extending from the xiphoid process to the pubic symphysis with transverse extension to the right just above the level of the umbilicus (Figure 4). Lysis of omental adhesions revealed compression of the right lobe of the liver and near complete atrophy of segments II and III. The tumor was gently rotated to the right and an umbilical tape was used to encircle the hepatic hilum in case a Pringle maneuver was necessary.


Enucleation after Embolization of Liver Failure-Causing Giant Liver Hemangioma.

Sharma A, Kaspar M, Siddiqui M, Kim J - Am J Case Rep (2015)

Pre-operative hepatic angiography. The left hepatic artery feeding the massive hemagioma was embolized successfully to achieve reduction in tumor size.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554336&req=5

f3-amjcaserep-16-563: Pre-operative hepatic angiography. The left hepatic artery feeding the massive hemagioma was embolized successfully to achieve reduction in tumor size.
Mentions: The patient underwent hepatic angiography (Figure 3) prior to the planned resection. An uncomplicated partial embolization of the giant hemangioma via the left hepatic artery using 2 vials of 500–700 micron diameter embospheres was performed. Two days later she was taken to the operating room. Our liver transplant team, including an anesthesiologist and support staff, participated in this surgery. Provisions were made for backbench ex vivo perfusion of the liver, if required. A massive transfusion protocol was set-up and a veno-venous bypass team was placed on standby. Surgical exposure of the giant hemangioma was obtained via a midline incision extending from the xiphoid process to the pubic symphysis with transverse extension to the right just above the level of the umbilicus (Figure 4). Lysis of omental adhesions revealed compression of the right lobe of the liver and near complete atrophy of segments II and III. The tumor was gently rotated to the right and an umbilical tape was used to encircle the hepatic hilum in case a Pringle maneuver was necessary.

Bottom Line: While typically benign, these tumors can occasionally grow to sufficient size to cause a number of symptoms, including pain, severe hepatic dysfunction, or, rarely, consumptive coagulopathy.In such instances, surgical treatment may be warranted.Early referral to experienced surgical centers before the onset of dire complications such as severe hepatic dysfunction and liver failure is recommended.

View Article: PubMed Central - PubMed

Affiliation: Division of Transplantation Surgery, Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA.

ABSTRACT

Background: Hepatic hemangioma is a congenital tumor of the mesenchymal tissues of the liver. While typically benign, these tumors can occasionally grow to sufficient size to cause a number of symptoms, including pain, severe hepatic dysfunction, or, rarely, consumptive coagulopathy. In such instances, surgical treatment may be warranted.

Case report: We present a case of a symptomatic giant hepatic hemangioma in an elderly patient who presented with impending liver failure. She was successfully treated with a combination of surgical enucleation and liver resection after preoperative arterial embolization. We also provide a brief discussion of current treatment options for giant hepatic hemangiomas.

Conclusions: Early referral to experienced surgical centers before the onset of dire complications such as severe hepatic dysfunction and liver failure is recommended.

No MeSH data available.


Related in: MedlinePlus