Ruptured hepatic adenoma. A spectrum of presentation and treatment

Six cases of ruptured hepatic adenoma treated in our medical center were reviewed with attention directed toward presenting symptomatology and methods of treatment. These patients, five women who were long-term users of oral contraceptives and one man who had never taken steroid medication, presented with right upper quadrant abdominal pain of variable degree and duration. The cardiovascular status of these patients was also variable, ranging from a normal blood pressure, which allowed an orderly workup, and planned resection of the tumor to hypovolemic shock requiring emergency laparotomy for control of hemorrhage. The extent of surgery depended on the location and the number of adenomas, with the goal being to resect the adenoma and control hemorrhage while preserving as much normal liver parenchyma as possible. The treatment of choice in this disease is resection of the tumor with a margin of normal liver parenchyma. In those cases in which that is not practical, resectional debridement has proven to be an effective alternative.