Related Experiment Videos
Treatment of ruptured hepatocellular adenoma
T Terkivatan1, J H de Wilt, R A de Man
1Department of Surgery, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands.
Background:
As the morbidity and mortality rates associated with emergency resection in patients with a ruptured hepatocellular adenoma are high, the authors have favoured initial non-operative management in haemodynamically stable patients.
Methods:
A retrospective study was performed to evaluate the treatment of ruptured hepatocellular adenoma.
Results:
Over a 21-year interval, 12 patients presented with a ruptured hepatocellular adenoma. Haemodynamic observation and support was the initial management in all 12 patients. Three underwent urgent laparotomy and gauze packing because of haemodynamic instability; no emergency liver resection was necessary. Eight patients had definitive surgery; three developed postoperative complications but none died. Regression of the tumour was observed in three of four patients treated conservatively.
Conclusion:
The initial management of a ruptured hepatocellular adenoma should be haemodynamic stabilization. Definitive resection is required for rebleeding or for tumours exceeding 5 cm in diameter. A conservative approach may well be justified in case of regression of an asymptomatic adenoma.