Intrapartum spontaneous rupture of liver hemangioma

Stavrou

J Hepato Biliary Pancreat

et al. 2011

Background The risk of spontaneous bleeding or rupture of liver hemangiomas still remains unknown. The aim of this review was to analyze the problem of spontaneous bleeding or rupture in liver hemangiomas and to identify factors leading to bleeding in these cases. Methods A MEDLINE search was undertaken to identify articles in English, French, German, Italian, and Spanish from 1898 to 2010. Basic data such as age and sex of patients were collected. Additional data such as risk factors or causes of rupture were also analyzed. Cases were divided into spontaneous and non-spontaneous ruptures. Results A total of 97 cases are described. In 51 of the 97 patients (52.6%) a non-spontaneous rupture was identified. Only in 46 out of the 97 cases (47.4%) was a spontaneous rupture found. Non-spontaneous rupture was significantly more frequent in patients aged\40 years than in older ones (p = 0.0099). Mean size of the ruptured lesions was 11.2 cm (range 1-37 cm). Massive bleeding occurred in 88 patients (90.7%). Reported mortality over the past 20 years has been significantly lower than before (p \ 0.001). The overall mortality for the period under study was *35%. ConclusionsThe spontaneous rupture of a hepatic hemangioma is to be considered an exceptional event. Preventive surgery should be considered only for lesions of at least 11-cm size in special cohorts of patients.

Section: Introductionmentioning

confidence: 99%

The risk of spontaneous rupture of liver hemangiomas: a critical review of the literature

Stavrou

J Hepato Biliary Pancreat

et al. 2011

“…Spontaneous rupture of liver neoplasms, including cavernous haemangiomata [11] , has also been described in the absence of pre-eclampsia toxaemia (PET), and the pathophysiology in these cases may be varied. Liver haemangiomata are common benign tumours of capillary endothelium, found in up to 20% of autopsy examinations [12] .…”

Section: Discussionmentioning

confidence: 98%

Spontaneous peripartum liver haemorrhage presenting as foetal distress

Holst¹,

McGuinness²,

Morris-Stiff³

2013

Grand Rounds

We present the case of a 32-year-old woman who presented at 37 weeks' gestation with foetal bradycardia. At caesarean delivery, an intra-abdominal haemorrhage was noted before the uterine incision was made. A subsequent exploratory laparotomy revealed the source of the bleeding to be an extensive ruptured haematoma involving both lobes of the liver. Radiologic investigations revealed the presence of multiple cavernous haemangiomata in the liver. The perioperative management of this patient is described, with a brief review of the literature.

The Obstetric & Gynaecologis

“…Clinically, haemangiomas rarely cause symptoms but have the potential to present with necrosis, infarction or thrombosis of the tumour. Very rarely these can rupture into the peritoneal cavity causing significant haemorrhage and this has been reported in pregnancy . Risk factors for haemorrhage include lesions greater than 10 cm in size or rapidly expanding lesions.…”

Section: Specific Liver Massesmentioning

confidence: 99%

“…Very rarely these can rupture into the peritoneal cavity causing significant haemorrhage and this has been reported in pregnancy. 14,16 Risk factors for haemorrhage include lesions greater than 10 cm in size or rapidly expanding lesions. Extremely rarely Kassabach-Merritt syndrome, a triad of very large or rapidly expanding haemangioma, thrombocytopenia and hypofibrinogenemia, can lead to significant complications.…”

Section: Hepatic Haemangiomasmentioning

confidence: 99%

“…9 There is a lack of substantive evidence that significant complications of liver haemangiomas are increased during pregnancy although many would closely observe hepatic haemangiomas of greater than 10 cm in diameter because of case reports of rupture. 14,16 There is no clear association between OCP use or estrogen exposure and development or enlargement of hepatic haemangiomas. 17 Given the benign nature of these lesions and very rare likelihood of complications these can be safely managed conservatively in most cases.…”

Section: Hepatic Haemangiomasmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and management of liver masses in pregnancy

Milburn

Black

Ahmed

et al. 2016

Key content Liver masses are increasingly detected in pregnancy because of the widespread use of abdominal ultrasonography. Most lesions are benign and can be treated conservatively, although rarely these can lead to clinical symptoms and the potential for significant haemorrhage. Diagnosis of liver masses is made primarily through radiological assessment with blood tests and rarely by direct liver biopsy. Collaboration between the obstetric department and specialist liver multidisciplinary team is essential to ensure optimal management. Learning objectives Review of liver masses in pregnancy. Overview of issues relevant in the prepregnancy and postpartum periods. Interventional management strategies for liver lesions. Ethical issues Should the diagnosis of a liver mass lead to termination of pregnancy? When should ionising radiation be used to aid diagnosis of liver masses? Are doctors aware of the risk of bleeding from a benign liver mass?