Salhanick M, MacConmara MP, Pedersen MR, Grant L, Hwang CS, Parekh JR. Two-stage liver transplant for ruptured hepatic adenoma: A case report. World J Hepatol 2019; 11(2): 242-249 [PMID: 30820274 DOI: 10.4254/wjh.v11.i2.242]
Corresponding Author of This Article
Malcolm P MacConmara, MD, Attending Doctor, Division of Surgical Transplantation, Department of Surgery, the University of Texas Southwestern Medical Center, 6201 Harry Hines Blvd, Dallas, TX 75390, United States. malcolm.macconmara@utsouthwestern.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Feb 27, 2019; 11(2): 242-249 Published online Feb 27, 2019. doi: 10.4254/wjh.v11.i2.242
Two-stage liver transplant for ruptured hepatic adenoma: A case report
Marc Salhanick, Malcolm P MacConmara, Mark R Pedersen, Lafaine Grant, Christine S Hwang, Justin R Parekh
Marc Salhanick, Division of Vascular Surgery, Department of Surgery, the University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
Malcolm P MacConmara, Christine S Hwang, Justin R Parekh, Division of Surgical Transplantation, Department of Surgery, the University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
Mark R Pedersen, Lafaine Grant, Division of Digestive and Liver Diseases, Department of Internal Medicine, the University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
Author contributions: Salhanick M and Pedersen MR wrote the paper; MacConmara MP, Hwang CS, Parekh JR and Grant L provided critical revision.
Informed consent statement: Given the nature of the patient’s condition at the time of hepatectomy and liver transplant, consent was obtained from the patient’s legal surrogate decision maker (her parents).
Conflict-of-interest statement: No authors have any conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Malcolm P MacConmara, MD, Attending Doctor, Division of Surgical Transplantation, Department of Surgery, the University of Texas Southwestern Medical Center, 6201 Harry Hines Blvd, Dallas, TX 75390, United States. malcolm.macconmara@utsouthwestern.edu
Telephone: +1-214-6458300 Fax: +1-214-6456771
Received: November 15, 2018 Peer-review started: November 15, 2018 First decision: November 27, 2018 Revised: January 3, 2019 Accepted: January 27, 2019 Article in press: January 28, 2019 Published online: February 27, 2019 Processing time: 103 Days and 19.3 Hours
Abstract
BACKGROUND
Only one case of liver transplantation for hepatic adenoma has previously been reported for patients with rupture and uncontrolled hemorrhage. We present the case of a massive ruptured hepatic adenoma with persistent hemorrhagic shock and toxic liver syndrome which resulted in a two-stage liver transplantation. This is the first case of a two-stage liver transplantation performed for a ruptured hepatic adenoma.
CASE SUMMARY
A 23 years old African American female with a history of pre-diabetes and oral contraceptive presented to an outside facility complaining of right-sided chest pain and emesis for one day. She was found to be in hemorrhagic shock due to a massive ruptured hepatic hepatic adenoma. She underwent repeated embolizations with interventional radiology with ongoing hemorrhage and the development of renal failure, hepatic failure, and hemodynamic instability, known as toxic liver syndrome. In the setting of uncontrolled hemorrhage and toxic liver syndrome, a hepatectomy with porto-caval anastomosis was performed with liver transplantation 15 h later. She tolerated the anhepatic stage well, and has done well over one year later.
CONCLUSION
When toxic liver syndrome is recognized, liver transplantation with or without hepatectomy should be considered before the patient becomes unstable.
Core tip: This case describes a rare and dramatic complication of a hepatic adenoma that resulted in both massive hemorrhage and toxic liver syndrome which could only be treated with hepatectomy. Recognition of toxic liver syndrome is essential when dealing with patients who suffer massive liver necrosis in attempts to control bleeding. Early consideration should be given to liver transplantation with or without hepatectomy before the patient becomes too unstable to proceed.
