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Multimodal management of endangering hepatic hemangioma: impact on transplant avoidance: a descriptive case series
Haley Draper1, Ivan R Diamond, Michael Temple
1Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Multimodal management, including embolization, shows promise for treating life-threatening hepatic hemangiomas in children. This approach may reduce the need for liver transplants in severe cases.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
- Hepatology
Background:
- Endangering hepatic hemangiomas can cause severe systemic compromise in infants.
- Multimodal management strategies are being explored for complex cases.
Purpose of the Study:
- To evaluate the outcomes of multimodal management for pediatric patients with endangering hepatic hemangioma.
- To assess the efficacy and safety of combined medical and interventional approaches.
Main Methods:
- Retrospective descriptive case series.
- Analysis of children with endangering hepatic hemangioma managed between 1996 and 2006.
- Inclusion of medical treatment and hepatic embolization procedures.
Main Results:
- Six children (mean age 1.9 months) with systemic compromise were treated.
- All patients received medical therapy and hepatic embolization (median 2 procedures).
- Four of six patients recovered; two died from sepsis and liver failure.
Conclusions:
- Multimodal management is a viable strategy for endangering hepatic hemangioma.
- This approach may potentially decrease the need for liver transplantation.
- Further evaluation of safety and efficacy is warranted.
Purpose:
To examine the results of the multimodal management of patients with endangering hepatic hemangioma associated with systemic compromise.
Methods:
Retrospective descriptive case series of children with endangering hepatic hemangioma managed at our institution between January 1996 and June 2006.
Results:
Six children (5 females) presented with endangering hepatic hemangioma with systemic effects during the index time period. Mean age at presentation was 1.9 months (range, 2 days to 4 months). All patients received medical treatment, and all patients also underwent hepatic embolization, with a median number of procedures of 2 (range, 1-6). Two patients died, one of sepsis and one of progressive liver failure in a child presenting with advanced liver disease owing to neonatal hemochromatosis that was unrecognized at the time. The remaining 4 patients all recovered and were discharged. With mean postprocedure follow-up of 2.11 years (range, 0-6.2 years), all remain well.
Conclusion:
Multimodal management of endangering hepatic hemangioma is a strategy that deserves consideration in the management of these patients. Although the strategy requires further evaluation as to its safety and efficacy, the procedure has the potential to decrease the need for liver transplantation because of treatment failures in this population.