Management of ruptured hepatocellular adenoma

Hepatocellular adenoma (HA) is an increasingly prevalent benign liver tumor that is strongly associated with use of oral contraceptive medication. The diagnosis is often made after abdominal imaging in female patients with sudden abdominal pain, with or without signs of hemorrhage. Especially larger adenomas are of potential hazard to patients, because of the increased likelihood of rupture or malignant degeneration. Standard treatment of larger adenomas has since long consisted in surgical resection, both for non-ruptured and for ruptured tumors. Although resection is still considered the gold standard, recent reports have advocated initial conservative management. Recently, newer and less invasive methods using selective transarterial embolization have been described that can successfully stop bleeding and even lead to tumor regression. This review addresses different treatment options and recent advances regarding this relatively new condition, focusing mainly on treatment of bleeding and ruptured tumors in an acute setting. A possible algorithm for optimal treatment is presented.