Giant ruptured hepatic hemangioma in pregnancy managed with a mixed approach: case report

Jorge A. Roldan-García, Department of Hepatopancreatobiliary Surgery, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
Ángel D. Pinedo-Vega, Department of General Surgery, Hospital General de Puebla Eduardo Vázquez N., Puebla, Puebla, Mexico
Pedro A. Hernández-Bernal, Department of General Surgery, Hospital General de Puebla Eduardo Vázquez N., Puebla, Puebla, Mexico
Edson Alquicira-Alcántara, Department of General Surgery, Hospital General de Puebla Eduardo Vázquez N., Puebla, Puebla, Mexico
Luis A. Albornoz-Ríos, Department of General Surgery, Hospital General de Puebla Eduardo Vázquez N., Puebla, Puebla, Mexico
Jorge G. Ixta-Felipe, Department of General Surgery, Hospital General de Puebla Eduardo Vázquez N., Puebla, Puebla, Mexico

Background: Hemangiomas are benign vascular tumors that can develop from the skin and even in intra-abdominal organs. Objective: The study aimed to describe the clinical case of a patient with ruptured hepatic hemangioma in the third trimester of pregnancy and its management. Clinical case: A 31-year-old female admitted with acute abdomen and fetal distress, cesarean section was performed with finding of hemoperitoneum, packing was performed with subsequent mixed approach with embolization and hepatectomy. Discussion: Its diagnosis during pregnancy is incidental and an association in its pathogenesis with growth and the elevated presence of sex hormones has been demonstrated. The management of this type of tumor is expectant when there is no presence of pain, growth, or rupture. Hemodynamic embolization will be useful before surgical management. Conclusion: Hemangioma is the most common benign liver tumor. In the case of this patient, it presented a severe complication that led to hypovolemic shock, which required intensive medical management and subsequent resection of the tumor with adequate evolution.

Keywords: Hepatic hemangioma. Ruptured hepatic hemangioma. Hypovolemic shock. Embolization. Partial hepatectomy.