Background: Hepatic hemangiomas warrant therapy if they are causing significant symptoms or are increasing in size. Enucleation is easier and safer than partial hepatectomy. Giant centrally located lesions are more challenging but can be treated with the same approach. Methods: A 70 years old man was referred to our hospital for pain in the right upper abdomen. CT scan revealed a central giant liver hemangioma compressing the cava and the suprahepatic veins with fissuration on segment 8. No signs of active bleeding were detected. The right diaphragm was elevated with concomitant right basal effusion and pneumonia. The size of the hemangioma was significantly increased in comparison with a previous exam taken 4 years before (main diameter from 9 to 12 cm). Patient was monitored after admission and surgey was delayed until the resolution of the pneumonia. Results: Resection of the caudate lobe and enucleation of the giant hemangioma under intermittent clamping was performed. After the caudate lobe was dissected from the caval vein the plan of dissection followed the capsule of the hemangioma to complete the enucleation from the surrounding parenchyma and the suprahepatic veins. Patient did't require transfusion. Postoperative course was uneventful and the patient was discharged 5 days after operation. Conclusion: Combined resection and enucleation is feasible also for centrally located giant hemangioma and need to be considered the safest approach when surgery become mandatory. It avoids complex liver resections.
Background: Laparoscopic total pericystectomy is not a widely used approach for surgical treatment of liver hydatid cyst (LHC). When laparoscopic surgery is perform, less than 10% of patients had a radical procedure. Methods: We present a case of previosly healthy 61 y/o man, who was diagnosed of LHC of segment VI by an abdominal US and CT scan. After serological analysis a LHC was confirmed. A preoperative treatment based in Albendazole was prescribed for 2 months. Under left lateral decubitus position, a four trocars approach was used. After a partial liver mobilization, isolation of field with gauze and hypertonic saline solution was done. Hydatid membranes was removed in a bag and complete pericystectomy using bipolar and ultrasonic scalpel was performed. Intraoperative bleeding was 50ml. A Jackson-Pratts drainage was left at surgical site. Results: Postoperative was uneventful and discharge at 2o postoperative day. Pathological study shows an inactive echinococcus with hyaline degeneration. After 10 months of follow-up are asymptomatic and no recurrence. Conclusion: Laparoscopic total pericystectomy is feasible and could be performed as method of choice to non complicated LHC.
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