Emergent Orthotopic Liver Transplantation for Hemorrhage from a Giant Cavernous Hepatic Hemangioma: Case Report and Review

Introduction Cavernous hemangiomas represent the most common benign primary hepatic neoplasm, often being incidentally detected. Although the majority of hepatic hemangiomas remain asymptomatic, symptomatic hepatic hemangiomas can present with abdominal pain, hemorrhage, biliary compression, or a co...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2011-01, Vol.15 (1), p.209-214
Main Authors: Vagefi, Parsia A., Klein, Ingo, Gelb, Bruce, Hameed, Bilal, Moff, Stephen L., Simko, Jeff P., Fix, Oren K., Eilers, Helge, Feiner, John R., Ascher, Nancy L., Freise, Chris E., Bass, Nathan M.
Format: Article
Language:English
Subjects:
Abdomen
Abdominal Cavity
Adult
Biopsy
Case Report
Case reports
Emergencies
Female
Gastroenterology
Hemangioma
Hemangioma, Cavernous - complications
Hemangioma, Cavernous - diagnosis
Hemangioma, Cavernous - surgery
Hemorrhage
Hemorrhage - etiology
Hemorrhage - surgery
Humans
Liver
Liver Neoplasms - complications
Liver Neoplasms - diagnosis
Liver Transplantation - methods
Medical imaging
Medicine
Medicine & Public Health
Surgery
Tomography, X-Ray Computed
Transplants & implants
Tumors
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Summary:Introduction Cavernous hemangiomas represent the most common benign primary hepatic neoplasm, often being incidentally detected. Although the majority of hepatic hemangiomas remain asymptomatic, symptomatic hepatic hemangiomas can present with abdominal pain, hemorrhage, biliary compression, or a consumptive coagulopathy. The optimal surgical management of symptomatic hepatic hemangiomas remains controversial, with resection, enucleation, and both deceased donor and living donor liver transplantation having been reported. Case Report We report the case of a patient found to have a unique syndrome of multiorgan cavernous hemangiomatosis involving the liver, lung, omentum, and spleen without cutaneous involvement. Sixteen years following her initial diagnosis, the patient suffered from intra-abdominal hemorrhage due to her giant cavernous hepatic hemangioma. Evidence of continued bleeding, in the setting of Kasabach-Merritt Syndrome and worsening abdominal compartment syndrome, prompted MELD exemption listing. The patient subsequently underwent emergent liver transplantation without complication. Conclusion Although cavernous hemangiomas represent the most common benign primary hepatic neoplasm, hepatic hemangioma rupture remains a rare presentation in these patients. Management at a center with expertise in liver transplantation is warranted for those patients presenting with worsening DIC or hemorrhage, given the potential for rapid clinical decompensation.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-010-1248-1