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