Published online Feb 27, 2019. doi: 10.4254/wjh.v11.i2.242
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
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.
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.
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.