Surgical Treatment of Giant Hepatic Hemangiomas: Technical Point of View

Abstract

Hepatic hemangiomas are the most common benign tumors of the liver. Surgical treatment can be difficult as a result of the high risk of intraoperative hemorrhage. The present study reviewed clinical features of patients with hepatic hemangioma and surgical techniques used in their treatment. Eight patients with giant hepatic hemangiomas underwent hepatectomies at the Asan Medial Center between January 2006 and March 2009. Patient demographic, clinical, and surgical characteristics and outcomes were reviewed retrospectively. Seven females and one male patient underwent hepatectomies during the study period. The median age was 48.5 years (range, 33 to 58 years). Indications for surgical interventions were abdominal pain (62.5%), an abdominal mass (37.5%), Kasabach-Merritt syndrome (25%), and increased hemangioma size (25%). The hemangiomas were usually multiple (87.5%) and bilobar (75%) and had a median size of 14.5 cm (range, 7 to 29 cm). All patients underwent major hepatic resection with early vascular control using the Glissonean pedicle transection method (GPTM), the liver hanging maneuver (LHM), and preparation for total vascular exclusion (TVE). There was no major morbidity or mortality. The minor morbidity rate was 25 per cent with transfusion rate of 37.5 per cent. Early vascular control using the GPTM, the LHM, and preparation for TVE is essential for safe resection of large hepatic hemangiomas.

Bilateral Lower Limb Edema Caused by Compression of the Retrohepatic Inferior Vena Cava by a Giant Hepatic Hemangioma

“…6 Hemangiomas are usually seen between the ages of 30-50 years, with a female-to-male ratio of 5-6:1. 2,6,8,9,11 Thus, it has been suggested that the disease is related to exogenous steroid hormones or gynecologic hormones, albeit studies have failed to show a definite connection. 1,3,6,9 Previous studies have shown that liver hemangiomas are usually smaller than 3 cm and 85% of lesions are asymptomatic.…”

“…Despite there being a lack of consensus with regards to the classification of giant hemangiomas, Adam et al described hemangiomas larger than 4 cm as ''giant.'' [3][4][5]8,11 Studies have suggested that there is a strong correlation between hemangioma diameter and symptoms. Hemangiomas larger than 10 cm are nearly always symptomatic.…”

“…1 In a very small minority of patients, signs and symptoms including nausea, vomiting, abdominal pain, palpable mass, obstructive jaundice, bleeding, Budd-Chiari syndrome, and edema and deep vein thrombosis in the lower limbs develop due to compression of the bile duct, hepatic vein, portal vein, inferior vena cava, or gastrointestinal system organs. [4][5][6][7][8] The most important factors contributing to these symptoms are the size, growth rate, and localization of the hemangioma in the liver. To our knowledge, only one case of liver hemangioma has been published so far that has reported edema and deep vein thrombosis of the lower limbs resulting from compression of the retrohepatic inferior vena cava.…”

Giant haemangioma of the liver with haemangiodudenal fistula: the first reported case in literature

“…As a result of this asymptomatic character, the size of the haemangioma varies greatly when discovered. 3 Adam et al defined giant haemangiomas as >4cm in diameter. 4 Giant liver haemangiomas can present with abdominal pain, fullness, mass, and complications such as platelet consumption coagulopathy (Kasabach-Merritt syndrome) and intraperitoneal haemorrhage due to rupture.…”

“…8,9 The most commonly reported complications of giant haemangiomas are rupture with intraperitoneal haemorrhage that is either traumatic or non-traumatic, consumption coagulopathy, Budd-Chiari syndrome and congestive heart failure. 3,10,11 Case History A 40-year-old woman presented to our hospital with right hypochondrial pain and fullness as well as severe pallor. Three years previously, she had one session of transcatheter arterial embolisation in a private clinic for a giant haemangioma involving the left hepatic lobe.…”