Case Report: Rare Acute Abdomen: Focal Nodular Hyperplasia With Spontaneous Rupture

Abstract

Focal nodular hyperplasia (FNH) of the liver is a benign lesion characterized by hypertrophic nodules with central star-shaped fibrous scars. The etiology and pathogenesis of FNH are not completely understood. A 43-year-old man was hospitalized because of acute abdominal pain. Emergency computed tomography(CT) showed hepatic tumor rupture and bleeding. The patient’s condition improved following arteriographic embolization to stop bleeding. Laparotomy confirmed spontaneous rupture and hemorrhage of focal hyperplasia and the patient remains asymptomatic after an uneventful recovery. FNH with spontaneous rupture and bleeding is extremely rare. Currently, there is no unified management standard for FNH and most previous studies recommend observation and follow-up. We recommend consideration of surgical treatment of cases with spontaneous rupture and bleeding.

Focal Nodular Hyperplasia: A Comprehensive Review with a Particular Focus on Pathogenesis and Complications

“…Size of the lesion might be related with greater risk of rupture and compressive effects upon adjacent structures (Table 1). 24,[42][43][44][45][46][47][49][50][51][53][54][55][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] Management with surgical resection, transarterial embolization or radiofrequency ablation should be considered in patients experiencing severe pain with no other identifiable cause or large or rapidly growing lesions with risk of causing complications.…”

“…It has been proposed that bleeding could be due to intratumoral vascular malformations and pressure build-up. 45 Histological components such as presence of telangiectasia, thickness of blood vessels, dilatation of sinuses or sinus fibrosis might play a role in the risk of spontaneous bleeding. Abdominal trauma may be associated with rupture, although many cases did not mention previous trauma but rather spontaneous rupture.…”

“… 1 Embolization of bleeding hepatic lesion can be successful in up to 99% of patients in the acute setting, followed by second-stage mass resection. 30 , 45 , 46 Techniques including arterial embolization and radiofrequency ablation could also be considered as alternatives to surgical resection.…”

Large focal nodular hyperplasia of the liver treated with transcatheter arterial embolization and laparoscopic resection: A case report

“…Most lesions are asymptomatic, do not change in size, and rarely cause complications; therefore, no treatment is required. However, when the tumor is large and protruding from the liver, therapeutic intervention should be considered because of the risk of rupture and hemorrhage 3,4 . Herein, we report a case of a large FNH of the liver exceeding 15 cm in size.…”

“…However, when the tumor is large and protruding from the liver, therapeutic intervention should be considered because of the risk of rupture and hemorrhage. 3,4 Herein, we report a case of a large FNH of the liver exceeding 15 cm in size. Preoperative transcatheter arterial embolization (TAE) resulted in a reduction in tumor size, and the patient could undergo safe laparoscopic hepatectomy.…”