Surgical Treatment of Giant Cavernous Hemangioma Liver

Abstract

In the past five years, 16 adults (10 females, age years, mean 48) with giant cavernous hemangioma of the liver measuring 15-31 cm (mean-19) underwent surgery in a single Institution. Diagnosis was made with the help of multimodal investigations-ultrasound (US), computed tomography (CT), hepatic angiography, hepatic scintigraphy and fine needle biopsy. Ultrasound and CT had sensitivities of 69% and 82% respectively. Fourteen had preoperative selective hepatic artery embolization to study its effect on operative blood loss. Indication for surgery in all cases was a large abdominal mass with varying severity of pain. In addition, 5 had hemetological and/or coagulation abnormalities, hemobilia in and pyrexia in 1. Seven left lobectomies, 3 left lateral segmentectomies, 2 right lobectomies, 2 right trisegmentectomies and 4 non-anatomical resections of to 3 segments were performed. Postoperative complications developed in 25% with no operative mortality. Preoperative selective hepatic artery embolization helped to decrease the operative hemorrhage in 13 (mean blood loss-1146 ml). In two cases severe bleeding required use of Cell-saver and massive donor blood transfusion. Our results suggest use of preoperative selective hepatic artery embolization and Cell-saver as an adjunct to the liver resection for these vascular tumors.

Giant Haemangioma of the Liver: Is Enucleation Better than Resection?

“…All the patients had a single giant haemangioma except 2 patients who had two haemangiomas each and 1 patient who had three. The surgical procedures carried out were enucleation ( n = 9) and liver resection ( n = 12; anatomical [8] and non-anatomical [4]). The anatomical liver resections carried out were extended right hepatectomy ( n = 2), right hepatectomy ( n = 1), left hepatic lobectomy ( n = 3) and bi-segmentectomy ( n = 2).…”

“…In our experience, it gave the diagnosis in 57.1% of the patients, which is similar to other series (58-69%). 7,8 However, it is an observer-dependent investigation and may miss details needed for guiding the surgeon. A good-quality, contrast-enhanced, dual-phase CT scan confirmed the diagnosis in 66.6% of our patients and provided surgical details of the vascular relationships, an experience reported by others (73-82%).…”

“…A good-quality, contrast-enhanced, dual-phase CT scan confirmed the diagnosis in 66.6% of our patients and provided surgical details of the vascular relationships, an experience reported by others (73-82%). [7][8][9] With the availability of MR scan, we have recently started using it more often in cases of a diagnostic dilemma after ultrasound and CT scans. A hyperintense lesion in the T2-weighted images is characteristic of a haemangioma.…”

Hemobilia caused by a giant benign hemangioma of the liver: Report of a case

“…This case was reported by Vishnevsky et al and described a patient with hemobilia who was treated surgically, but no further details were given. 7 Although their case is the first report of hemobilia induced by benign hemangioma to date, we believe that the present report describes the first case of hemobilia caused by a giant cavernous hemangioma which was proven histopathologically.…”

Das kavernöse Leberhämangiom: Rationale Diagnostik und therapeutisches Vorgehen

“…Da die meisten Hämangiome, wie auch andere benigne Lebertumoren, von einer fibrösen Kapsel umgeben sind, ist das Ausschälen ohne größere Blutverluste möglich. Zur Vermeidung allogener Bluttransfusionen, insbesondere bei großen Befunden, wird der Einsatz des cell savers zur Autotransfusion empfohlen [57].…”