Elsevier

Hepatology Research

Volume 23, Issue 2, June 2002, Pages 145-151
Hepatology Research

Intrahepatic huge hematoma due to rupture of small hepatocellular adenoma: a case report

https://doi.org/10.1016/S1386-6346(01)00164-4Get rights and content

Abstract

Hepatocellular adenoma sometimes causes intraperitoneal hemorrhage. It is, however, rare for small hepatocellular adenoma to cause intrahepatic huge hemorrhage without intraperitoneal bleeding. Here we describe such a rare case of hepatocellular adenoma with huge intrahepatic hemorrhage in a 25-year-old female, who had taken oral contraceptives for the last 2 weeks. She was admitted to our hospital with a sudden onset of right-upper-quadrant abdominal pain and temporally fell in shock state. Plain CT depicted low density area measuring more than 13 cm in diameter in the right lobe of the liver. Huge tumor was also suggested by abdominal ultrasound, contrast enhanced CT, magnetic resonance imaging (MRI) and angiography. The patient was diagnosed as intrahepatic rupture of hepatic tumor. Because of the risk of re-hemorrhage and malignancy, she underwent right hepatic lobectomy. Histopathologial examination of the resected specimen showed a typical small hepatocellular adenoma with the surrounding huge hematoma in the liver. The case presented here is very rare but seems to be suggestive to the natural course and management of hepatocellular adenoma.

Introduction

Hepatocellular adenoma is a relatively uncommon tumor which affect patients with prior history of oral contraceptive use, androgenic steroid use or glycogen storage disease. Most of patients with hepatocellular adenoma are clinically asymptomatic [1], [2], [3], [4], [5], [6], [7], [8], [9]. However, in some cases sudden onset of abdominal pain due to rupture of the tumor with subsequent intraperitoneal hemorrhage occasionally occurs [1], [2], [3]. Different from the intraperitoneal hemorrhage, intrahepatic hemorrhage of small adenoma is extremely rare [4], [5]. In this article we report such a rare case of small hepatocellular adenoma less than 2 cm in diameter presenting sudden onset of huge intrahepatic hemorrhage resulting in a hypovolemic shock.

Section snippets

Case report

A 25-year-old female with no recent history of abdominal trauma or hepatitis presented a sudden onset of severe epigastric pain. She had a history of taking oral contraceptives only for 2 weeks. In the ambulance car, she had been in a transient shock state. However, on arrival on emergency unit of our institution, she was afebrile and hemodynamically stable with minimal abdominal tenderness on physical examination. Her hemoglobin was 11.2 g/dl, white blood cell count was 10 100/mm3, total

Discussion

Hepatocellular adenomas are relatively rare benign neoplasms with a yearly incidence of one per million populations, and almost occur in women; the female-to-male ratio is 9:1. Anabolic steroid including contraceptive use, diabetes mellitus and type I and III glycogen storage disease have also been associated with their development [4], [6]. Hepatocellular adenomas sometimes occur in the absence of any obvious cause [2]. This case is considered to belong to the last category because of too

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