Giant liver hemangioma resected by trisectorectomy after efficient volume reduction by transcatheter arterial embolization: a case report
IntroductionLiver hemangiomas are the most common benign liver tumors, usually small in size and requiring no treatment. Giant hemangiomas complicated with consumptive coagulopathy (Kasabach-Merritt syndrome) or causing severe incapacitating symptoms, however, are generally considered an absolute indication for surgical resection.
Here, we present the case of a giant hemangioma, which was one of the largest ever reported.Case presentationA 38-year-old Asian man was referred to our hospital with complaints of severe abdominal distension and pancytopenia. Examinations at the first visit revealed a right liver hemangioma occupying abdominal cavity, protruding into the right diaphragm up to the right thoracic cavity and extending down to the pelvic cavity, with a maximum diameter of 43 cm, complicated with an "asymptomatic"Kasabach-Merritt syndrome.
Based on the tumor size and the anatomic relation between the tumor and hepatic vena cava, primary resection seemed difficult and dangerous, leading us to first perform transcatheter arterial embolization to reduce the tumor volume and to ensure the safety of future resection. The tumor volume was significantly decreased by two successive transcatheter arterial embolizations, and a conventional right trisectorectomy was then performed to resect the tumor without difficulty.
Conclusion: To date, there are several reports of aggressive surgical treatments, including extracorporeal hepatic resection and liver transplantation, for huge hemangiomas like the present case, but because of its benign nature, every effort should be made to avoid the life-threatening surgical stress for the patient.
Our experience demonstrates that a preoperative arterial embolization may effectively enable the resection of large hemangiomas.
Author: Nobuhisa AkamasuYasuhiko SugawaraMasahiko KomagomeTakashi IshidaNobuhiro ShinNarihiro ChoFumiaki OzawaDaijo Hashimoto
Credits/Source: Journal of Medical Case Reports 2010, 4:283
Published on: 2010-08-23
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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