Surgical Management of Spontaneous Ruptured Hepatocellular Adenoma

Abstract

AIMSSpontaneous ruptured hepatocellular adenoma (SRHA) is a rare life-threatening condition that may require surgical treatment to control hemorrhaging and also stabilize the patient. We report a series of emergency surgeries performed at our institution for this condition.METHODSWe reviewed medical records and radiology files of 28 patients (from 1989 to 2006) with a proven diagnosis of hepatocellular adenoma (HA). Three (10.7%) of 28 patients had spontaneous ruptured hepatocellular adenoma, two of which were associated with intrahepatic hemorrhage while one had intraperitoneal bleeding. Two patients were female and one was male. Both female patients had a background history of oral contraceptive use. Sudden abdominal pain associated with hemodynamic instability occurred in all patients who suffered from spontaneous ruptured hepatocellular adenoma. The mean age was 41.6 years old. The preoperative assessment included liver function tests, ultrasonography and computed tomography.RESULTSThe surgical approaches were as follows: right hemihepatectomy for controlling intraperitoneal bleeding, and right extended hepatectomy and non-anatomic resection of the liver for intrahepatic hemorrhage. There were no deaths, and the postoperative complications were bile leakage and wound infection (re-operation), as well as intraperitoneal abscess (re-operation) and pleural effusion.CONCLUSIONSpontaneous ruptured hepatocellular adenoma may be treated by surgery for controlling hemorrhages and stabilizing the patient, and the decision to operate depends upon both the patient’s condition and the expertise of the surgical team.

Liver Transplantation for Treatment of Unresectable Spontaneous Ruptured Hepatocellular Adenoma: A Rare Indication

“…However, considering the high risk of morbidity and mortality with emergent surgery, TAE should be considered to stabilize the patient, and the liver resection should be delayed to an elective procedure. Also, some authors have suggested that TAE can reduce or even lead to the disappearance of some tumors [ 1 - 2 , 4 - 8 , 10 , 15 ].…”

One stage resection of spontaneous rupture of hepatocellular carcinoma in the triangular ligament with diaphragm invasion: case report and review of the literature

“…The management of ruptured HCC is achieved by many techniques depending on the stability of the patient. If the patient is hemodynamically stable, conservative treatment with close monitoring and correction of coagulopathy is the gold standard of care [17]. On the other hand, if the patient is hemodynamically unstable, as in our case, he or she may need surgical interventions after resuscitation.…”

Perfil dos pacientes operados por Adenoma Hepático em Serviço de Cirurgia Hepatobiliar do Rio Grande do Sul

“…Nos casos de lesão rota, a escolha entre abordagem aberta ou laparoscópica deve levar em consideração os recursos disponíveis e a experiência do cirurgião. Embolização arterial seletiva tem papel crescente no tratamento de adenomas rotos e não-rotos, e atua induzindo necrose tumoral com menores taxas de complicações quando comparada a operações no contexto de urgência 15,16 .…”