Case Report
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World J Gastroenterol. Jul 21, 2013; 19(27): 4422-4426
Published online Jul 21, 2013. doi: 10.3748/wjg.v19.i27.4422
Rupture of a hepatic adenoma in a young woman after an abdominal trauma: A case report
Ricardo Lemos Cotta-Pereira, Luana Ferreira Valente, Daniela Goncalves De Paula, Antônio Luís Eiras-Araújo, Antônio Carlos Iglesias
Ricardo Lemos Cotta-Pereira, Luana Ferreira Valente, Antônio Carlos Iglesias, Department of Surgery, Federal University of Rio De Janeiro State (UNIRIO), Rio de Janeiro, RJ 20270-004, Brazil
Daniela Goncalves De Paula, Department of Surgery, Militar Police Hospital (HPMRJ) Rio de Janeiro, RJ 20270-004, Brazil
Antônio Luís Eiras-Araújo, Department of Radiology, Federal University of Rio de Janeiro (UFRJ) and Instituto D'Or, Rio de Janeiro, RJ 20270-004, Brazil
Author contributions: Cotta-Pereira RL treated the patient and drafted the paper; Valente LF and De Paula DG made substantial contributions to the research design and patient treatment; Eiras-Araújo AL contributed to radiological imaging examination and diagnosis; Iglesias AC have read and approved the final version to be published.
Correspondence to: Ricardo Lemos Cotta-Pereira, MD, Department of Surgery, Federal University of Rio De Janeiro State (UNIRIO), Rua Mariz e Barros 775, 6a Enfermaria, Tijuca, Rio de Janeiro, RJ 20270-004, Brazil. ricardo.cotta@me.com
Telephone: +55-21-87664595 Fax: +55-21-87664595
Received: February 24, 2013
Revised: May 15, 2013
Accepted: May 18, 2013
Published online: July 21, 2013
Processing time: 146 Days and 12.2 Hours
Abstract

Unlike hepatic haemorrhage following blunt abdominal trauma, spontaneous abdomen bleeding is rare, even in the presence of a hepatocellular adenoma (HA) or carcinoma. However, the diagnosis of a tumour underlying a haematoma after liver trauma is unusual, especially when it occurs more after two years after the accident. Here, we report a case of a ruptured HA due to blunt abdominal trauma. A 36-year-old woman was admitted to our hospital with sudden onset of upper abdominal pain. Her medical history revealed a blunt abdominal trauma two years prior. Initial abdominal computed tomography scan revealed a large haematoma measuring more than 16 cm in diameter in the right lobe of the liver. Magnetic resonance imaging showed haemorrhagic areas and some regions with hepatocyte hyperplasia, suggesting HA. The patient underwent right hepatic lobectomy, and a histopathological examination confirmed a diagnosis of HA. In conclusion, it is important to consider that abdominal trauma may hide old, asymptomatic and not previously detected injuries, as in the case reported.

Keywords: Hepatic adenoma; Treatment; Hemoperitoneum; Trauma; Computed tomography

Core tip: This paper clarifies that surgical liver diseases should be evaluated by experts at specialized centers. In addition, experts should pay attention to unusual situations as reported. Asymptomatic liver tumors are more common than imagined, even when presented underlying other acute disease, such as blunt trauma.