Spontaneous rupture of hepatic hemangiomas: A review of the literature

Abstract

Hepatic hemangiomas are congenital vascular malfor mations, considered the most common benign me senchymal hepatic tumors, composed of masses of blood vessels that are atypical or irregular in arran gement and size. Hepatic hemangiomas can be divided into two major groups: capillary hemangiomas and cavernous hemangiomas These tumors most frequently affect females (80%) and adults in their fourth and fifth decades of life. Most cases are asymptomatic although a few patients may present with a wide variety of cli nical symptoms, with spontaneous or traumatic rup ture being the most severe complication. In cases of spontaneous rupture, clinical manifestations consist of sudden abdominal pain, and anemia secondary to a haemoperitoneum. Disseminated intravascular coagulo pathy can also occur. Haemodynamic instability and signs of hypovolemic shock appear in about one third of cases. As the size of the hemangioma increases, so does the chance of rupture. Imaging studies used in the diagnosis of hepatic hemangiomas include ultra sonography, dynamic contrastenchanced computed tomography scanning, magnetic resonance imaging, hepatic arteriography, digital subtraction angiography, and nuclear medicine studies. In most cases hepatic hemangiomas are asymptomatic and should be followed up by means of periodic radiological examination. Sur gery should be restricted to specific situations. Ab solute indications for surgery are spontaneous or trau matic rupture with hemoperitoneum, intratumoral blee ding and consumptive coagulopathy (KassabachMerrit syndrome). In a patient presenting with acute abdo minal pain due to unknown abdominal disease, sponta neous rupture of a hepatic tumor such as a hemangio ma should be considered as a rare differential diagno sis.

Hepatic Hemangioma Rupture Caused by Blunt Trauma

“…When rupture occurs spontaneously or by trauma, symptoms such as sudden abdominal pain and distension with hemoperitoneum may appear, leading to coagulopathy and hypovolemic shock [2].…”

“…The mortality rate in patients with spontaneous or traumatic hepatic hemangioma rupture is approximately 35% [2].…”

“…The prevalence of spontaneous rupture of hepatic hemangiomas ranges from 1% to 4%, and that of traumatic rupture remains unknown [2,3]. The mortality rate in patients with spontaneous or traumatic hepatic hemangioma rupture is approximately 35% [2].…”

“…Hepatic hemangiomas are the most frequently occurring benign tumors of the liver. However, most patients are not aware of the existence of hemangiomas, which are incidentally diagnosed during imaging studies or surgical abdominal exploration [2]. Spontaneous or traumatic rupture of hepatic hemangioma is rare and can cause serious bleeding and life threatening conditions.…”

Spontaneous Rupture of Liver Haemangioma-A Case Report & Review of Literature

“…The management of a large (i. e, >10 cm) hepatic haemangioma is controversial .However, a literature search identified only 32 published cases of spontaneous rupture in adults without a history of trauma [1,6,8,12,15,[19][20][21][22][23][24][25][26][27][28][29][30]. However, actual radiological documented before and after ruptured are not well documented.…”