Case report: successful open resection of a symptomatic giant liver haemangioma during the second trimester of pregnancy

Abstract

Liver haemangiomas are consistently reported to be the commonest benign liver tumours and are most often incidental findings in asymptomatic individuals. Large lesions can become symptomatic, spontaneously rupture or result in a consumptive coagulopathy known as Kasabach–Merrit Syndrome. It is believed that the female sex hormones, particularly oestrogen, have an influence on haemangioma development and growth. The optimal management of large haemangiomas during the hyperoestrogenic state of pregnancy is poorly described in the current literature. To our knowledge, we describe only the second case of a giant hepatic haemangioma resection during pregnancy.

Multidisciplinary management of the pregnant patient in haemorrhagic shock secondary to an undiagnosed ruptured liver adenoma

“…This is one of the first case reports describing a multidisciplinary management strategy for treating a ruptured hepatic adenoma during pregnancy including those of obstetrics and gynaecology, general surgery and IR. Other case reports exist discussing the resection of a hepatic mass during pregnancy, but this was prior and separate to delivery of the infant 7 8. Our patient and her infant had a good outcome despite the large blood loss, mainly due to early detection of maternal and fetal compromise and expeditious exploratory laparotomy and liver packing by the acute care general surgery team with definitive control by the IR team.…”

Ruptured Hepatic Hemangioma in the Third Trimester of Pregnancy: A Rare Case Report

“…A study reported by Schnaper et al demonstrated that estrogen enhances endothelial cell proliferation, migration, and organization into capillary-like structures which leads to increased angiogenesis [ 8 ]. For this reason, accelerated growth caused by increased estrogen in pregnancy, as well as increased intra-abdominal pressure, and direct contact with a gravid uterus are possible mechanisms for increased risk of rupture during pregnancy [ 5 , 9 ].…”