Torsion of a giant pedunculated liver hemangioma mimicking acute appendicitis: a case report

Abstract

Hemangiomas are the most common benign neoplasms affecting the liver. They occur at all ages. Most cases are asymptomatic and do not require any treatment. Rarely, hemangiomas can be pedunculated. İf they undergo torsion and infarction, they become symptomatic. Herein; we report the case of a 31 year old male presenting with features of acute appendicitis: continuous right iliac fossa pain, rebound, guarding tenderness at McBurney' s point, nausea, anorexia, shifted white blood cell count and a Mantrels score of 6. At laparotomy a normal appendix was observed and a torsioned pedinculated liver hemangioma turned out to be the cause.

Giant pedunculated hemangioma of the liver

“…Hemangioma is the most common benign liver tumor (1-8) , with a prevalence of 0.4-20% in necropsies (1,5-8) . In most cases, hemangiomas are small, asymptomatic and incidentally found at imaging studies (1,2,5,6) .…”

“…In most cases, hemangiomas are small, asymptomatic and incidentally found at imaging studies (1,2,5,6) .…”

“…In spite of the lack of consensus about the dimensions to define a giant hemangioma, ranging from 4 to 10 cm according to the literature, it is known that the exophytic presentation, particularly those pedunculated, are very rare (1-3,5,6) . The first case was reported by Ellis et al in 1985; and up to 2013, only 24 cases were described in the literature (1,4) .…”

“…In almost 50% of cases, pedunculated hemangiomas are symptomatic at the diagnosis (1) and, likely any giant lesion, may determine compression of the intrahepatic biliary ducts, vascular structures or adjacent organs, manifesting with pain, early satiety, hemorrhage, jaundice, nausea and vomiting (1,2,5,6,8) . Main complications include torsion due to a long and mobile pedicle, infarction (5,6) , spontaneous or traumatic rupture, congestive heart failure, and Kasabach-Merritt syndrome (2,6,7) .…”

“…Main complications include torsion due to a long and mobile pedicle, infarction (5,6) , spontaneous or traumatic rupture, congestive heart failure, and Kasabach-Merritt syndrome (2,6,7) .…”