Review
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World J Hepatol. Dec 27, 2010; 2(12): 428-433
Published online Dec 27, 2010. doi: 10.4254/wjh.v2.i12.428
Spontaneous rupture of hepatic hemangiomas: A review of the literature
Marcelo AF Ribeiro Jr, Francine Papaiordanou, Juliana M Gonçalves, Eleazar Chaib
Marcelo AF Ribeiro Jr, Department of Surgery, Medical School, University of Santo Amaro, São Paulo 04829300, Brazil
Marcelo AF Ribeiro Jr, Professor of Surgery at University Cidade de São Paulo, São Paulo, 03071000, Brazil
Francine Papaiordanou, Juliana M Gonçalves, Medical Student at Universidade Cidade de São Paulo, São Paulo 03071000, Brazil
Eleazar Chaib, Liver and Portal Hypertension Surgery, Clinicas Hospital, University of São Paulo Medical School, São Paulo 01293903, Brazil
Eleazar Chaib, Visiting Professor, Nuffield Department of Surgery, Churchill Hospital, University of Oxford, Oxford, OX1 3DW, United Kingdom
Author contributions: Ribeiro Jr MAF and Chaib E designed the research; and Ribeiro Jr MAF, Papaiordanou F and Gonçalves JM performed the research, analyzed the data and wrote the paper.
Correspondence to: Marcelo AF Ribeiro Jr, MD, PhD, FACS, Department of Surgery, Medical School, University of Santo Amaro, São Paulo 04829300, Brazil. mribeiro@cwaynet.com.br
Telephone: +55-11-21418643
Received: August 23, 2010
Revised: October 26, 2010
Accepted: November 2, 2010
Published online: December 27, 2010
Abstract

Hepatic hemangiomas are congenital vascular malformations, considered the most common benign mesenchymal hepatic tumors, composed of masses of blood vessels that are atypical or irregular in arrangement and size. Hepatic hemangiomas can be divided into two major groups: capillary hemangiomas and cavernous hemangiomas These tumors most frequently affect females (80%) and adults in their fourth and fifth decades of life. Most cases are asymptomatic although a few patients may present with a wide variety of clinical symptoms, with spontaneous or traumatic rupture being the most severe complication. In cases of spontaneous rupture, clinical manifestations consist of sudden abdominal pain, and anemia secondary to a haemoperitoneum. Disseminated intravascular coagulopathy can also occur. Haemodynamic instability and signs of hypovolemic shock appear in about one third of cases. As the size of the hemangioma increases, so does the chance of rupture. Imaging studies used in the diagnosis of hepatic hemangiomas include ultrasonography, dynamic contrast-enchanced computed tomography scanning, magnetic resonance imaging, hepatic arteriography, digital subtraction angiography, and nuclear medicine studies. In most cases hepatic hemangiomas are asymptomatic and should be followed up by means of periodic radiological examination. Surgery should be restricted to specific situations. Absolute indications for surgery are spontaneous or traumatic rupture with hemoperitoneum, intratumoral bleeding and consumptive coagulopathy (Kassabach-Merrit syndrome). In a patient presenting with acute abdominal pain due to unknown abdominal disease, spontaneous rupture of a hepatic tumor such as a hemangioma should be considered as a rare differential diagnosis.

Keywords: Hepatic hemangioma; Giant hepatic hemangioma; Liver tumor; Spontaneous rupture; Surgery