Case Report
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World J Gastroenterol. May 21, 2013; 19(19): 2974-2978
Published online May 21, 2013. doi: 10.3748/wjg.v19.i19.2974
Successful liver resection in a giant hemangioma with intestinal obstruction after embolization
Ji-Xiang Zhou, Ji-Wei Huang, Hong Wu, Yong Zeng
Ji-Xiang Zhou, Ji-Wei Huang, Hong Wu, Yong Zeng, Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Zhou JX, Wu H and Zeng Y designed this study; Zhou JX and Huang JW collected, analyzed and interpreted data; Zhou JX drafted the article; all authors critically reviewed and approved the manuscript; Zhou JX and Zeng Y are principal investigators for the project.
Correspondence to: Yong Zeng, MD, Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. zengyongmd@163.com
Telephone: +86-288-5422474 Fax: +86-288-5422474
Received: October 9, 2012
Revised: January 17, 2013
Accepted: March 28, 2013
Published online: May 21, 2013
Processing time: 222 Days and 16.1 Hours
Abstract

Hepatic hemangiomas are the most common benign tumor of the liver. Most hepatic hemangiomas remain asymptomatic and require no treatment. Giant hepatic hemangiomas with established complications, diagnostic uncertainty and incapacitating symptoms, however, are generally considered an absolute indication for surgical resection. We present a case of a giant hemangioma with intestinal obstruction following transcatheter arterial embolization, by which the volume of the hemangioma was significantly reduced, and it was completely resected by a left hepatectomy. A 21-year-old Asian man visited our hospital for left upper quadrant pain. Examinations at the first visit revealed a left liver hemangioma occupying the abdominal cavity, with a maximum diameter of 31.5 cm. Embolization of the left hepatic artery was performed and confirmed a decrease in its size. However, the patient was readmitted to our hospital one month after embolization for intestinal obstruction. A left hepatectomy was completed through a herringbone incision, and safely removed a giant hemangioma of 26.5 cm × 19.5 cm × 12.0 cm in size and 3690 g in weight. Pre-operative arterial embolization is effective for reducing tumor size, but a close follow-up to decide the time for hepatectomy is important.

Keywords: Hepatic hemangioma; Transcatheter arterial embolization; Intestinal obstruction; Complications; Hepatectomy

Core tip: Hepatic hemangiomas are the most common benign tumor of the liver. Most hepatic hemangiomas remain asymptomatic and require no treatment; giant hepatic hemangiomas with established complications, diagnostic uncertainty and incapacitating symptom, however, are generally considered an absolute indication for surgical resection. We present a case of a giant hemangioma with intestinal obstruction following transcatheter arterial embolization, by which the volume of the hemangioma was significantly reduced, and it was completely resected by a left hepatectomy. Our experience indicates the effectiveness of pre-operative arterial embolization to reduce tumor size, and the importance of a close follow-up to decide when to perform the surgery.