Major liver resection in pregnancy: three cases with different etiologies and review of the literature

Abstract

Major liver resection can be performed safely during pregnancy. A multidisciplinary team of surgeons, anesthesiologists and gynecologists, in a highly experienced tertiary hepatobiliary center, should be involved.

Multidisciplinary management of the pregnant patient in haemorrhagic shock secondary to an undiagnosed ruptured liver adenoma

“…This is one of the first case reports describing a multidisciplinary management strategy for treating a ruptured hepatic adenoma during pregnancy including those of obstetrics and gynaecology, general surgery and IR. Other case reports exist discussing the resection of a hepatic mass during pregnancy, but this was prior and separate to delivery of the infant 7 8. Our patient and her infant had a good outcome despite the large blood loss, mainly due to early detection of maternal and fetal compromise and expeditious exploratory laparotomy and liver packing by the acute care general surgery team with definitive control by the IR team.…”

Cholangiocarcinoma in pregnancy: a case report

“…Liver diseases complicate the courses of about 3% of all pregnancies and may have detrimental effects on the mother and fetus, but CCA during pregnancy is rare. In PubMed database, 14 such cases have been identified during 1975 to 2019 [6][7][8][9][10][11][12][13][14][15][16][17][18][19] . Patients were aged 25 to 40 years, and no risk factor was identified in most patients.…”

“…In most cases, babies are delivered prematurely to facilitate investigations and treatment when the diagnosis is suspected or confirmed. In only one case, the patient underwent extended left hepatectomy for intrahepatic CCA at 30 weeks of gestation while continuing the pregnancy and eventually had a normal vaginal delivery at 38 weeks of gestation 8 . In the management of malignancy, early treatment and long-term outcome should be prioritised 8 .…”

Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases

“…The caveat to this approach is for cavernous hemangiomas, ranging from greater than 5 cm to greater than 10 cm, for which the increased intra-abdominal pressure of the expanding uterus, increase in blood volume, and up-regulation of cytokines predisposes to continued expansion and potential rupture, although rupture is quite rare. (259,260) Resection of giant cavernous hemangiomas, although rarely employed, has been safely reported in three cases during the second trimester of pregnancy, without maternal or fetal death. (260)(261)(262) New onset of symptoms should prompt investigation, and the decision to intervene should be approached with caution and determined on a case-by-case basis, guided by symptoms and risk to maternal and fetal outcomes.…”

“…(259,260) Resection of giant cavernous hemangiomas, although rarely employed, has been safely reported in three cases during the second trimester of pregnancy, without maternal or fetal death. (260)(261)(262) New onset of symptoms should prompt investigation, and the decision to intervene should be approached with caution and determined on a case-by-case basis, guided by symptoms and risk to maternal and fetal outcomes.…”