Hemorrhagic Rupture of a Hepatic Adenoma in a Postmenopausal Female: A Case Report

Hepatic adenoma (HA) is a rare benign liver lesion most commonly observed in females of reproductive age using oral contraceptive pills (OCPs). Though typically asymptomatic, HA may lead to complications such as hemorrhage or malignant transformation. Current literature highlights an increased risk of hemorrhage in larger lesions among premenopausal females and transformation to hepatocellular carcinoma in postmenopausal females. This report discusses a case of a 58-year-old postmenopausal female who presented with a sudden onset of back pain, syncope, nausea, and vomiting. CT imaging revealed moderate- to large-volume intraperitoneal fluid concerning for hemoperitoneum and a right hepatic mass, prompting urgent surgical intervention. The patient was ultimately diagnosed with a hemorrhagic rupture of a 3.8-cm HA. Postoperatively, the patient was advised to discontinue OCP use and undergo repeat imaging in three months. Subsequent scans revealed a minor increase in size and a slight elevation in alpha-fetoprotein. The patient has been referred to oncology for further recommendations. This case aims to increase recognition of HA complications, specifically hemorrhage as a potentially fatal presentation, which can present atypically, even in postmenopausal patients.