Surgical Treatment of Liver Hemangioma – Case Report

Abstract

Background

The increase of usage of imaging techniques, such as ultrasound, MRI and CT has also raised our awareness about benign liver tumors. A higher specificity of these methods reduces the need for percutaneous biopsy. A liver hemangioma must be differentiated from other bening solid tumors of the liver: hepatocellular adenoma, hepatocellular focal nodular hyperplasia, angiomyolipoma and leiomyoma. Liver hemangiomas have clear imaging features and are mostly asymptomatic.

Case presentation

Our 52 years old female patient had been following regularly her liver hemangioma for the last five years. Lately she was experiencing epigastric and RUQ pain after meals, and the dimensions of the hemangioma reached 10cm, with an involvement of the segments II-III and IV. Considering the dimensions and most importantly the clinical signs, the decision was made for the surgical treatment. A left reglee hepatectomy was performed. The patient made a full recovery and was discharged.

Discussion

The overwhelming majority of liver hemangiomas are asymptomatic and are incidentally diagnosed in routine ultrasound examinations. They comprise about 70% of all benign hepatic lesions. Because of the clear imaging features of liver hemangiomas, the role of radiologic studies is emphasized. Despite the varying dimensions, asymptomatic hemangiomas have no recommended treatment. No lifestyle changes or medications contribute to improved outcomes. However, when hemangiomas become symptomatic, there are three therapeutic options. 1) Hepatic artery ligation; 2) Radiofrequency ablation 3) Surgical resection.

Conclusion

In conclusion, the management of liver hemangiomas may vary from watchful radiologic observation, to radiologic and major surgical interventions. The most common indication for a surgical approach is the presence of various symptoms (mostly abdominal pain) with the increase in size. Although more voluminous tumors are likely to cause more symptoms, size alone is not an indication. Prophylactic resection for giant hemangiomas (>10cm) is not recommended, as the risk for hemorrhage and complications is to be considered. In this specific case, the following arguments were considered for proposing a surgical treatment: a) the tumor has become symptomatic (abdominal pain), b) patients willingness and cooperation to remove the tumor, c) hemangioma size of 10cm, which has a higher risk of traumatic rupture.

Keywords: General Surgery, Hepatobiliary Surgery, Liver Hemangioma, Liver Resection, Left Hepatectomy.

DOI: 10.7176/JEP/14-32-03

Publication date: November 30^th 2023