Related Experiment Video
Updated: Aug 6, 2026
Laparoscopic Anatomical Right Hemihepatectomy via the In Situ Anterior Approach
Published on: August 8, 2025
Orthotopic Liver Transplantation for Giant Hepatic Hemangioma Involving the Entire Liver With Intra-Abdominal
Daniel Reis Waisberg1, Jhosimar Alvarez De La Hoz1, Maciana Santos Silva1
1Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, São Paulo, Brazil.
Introduction:
Hepatic hemangioma (HH) is the most common benign liver tumor, usually <4 cm and asymptomatic. Rarely, lesions become massive or diffuse, causing severe abdominal mass effect or complications such as Kasabach-Merritt syndrome with consumptive coagulopathy. When surgical resection is unfeasible, liver transplantation (LT) may be considered. Adult LT for unresectable HH is extremely rare, with only 27 cases reported worldwide. The aim of this study is to describe a case of giant HH that encompassed the whole liver and caused abdominal hypertension, eventually requiring LT.
Case Report:
A male patient with HH presented with progressive hepatomegaly, abdominal pain, weight loss, reduced intake, edema, dental bleeding, and pancytopenia. Deceased-donor LT was performed using a modified left-to-right piggyback technique and a Mercedes incision. The explanted liver weighed 8.675 kg with near-total parenchymal replacement by diffuse hemangiomatosis. Postoperative recovery was uneventful, and he was discharged home 11 days after the procedure. The patient remains clinically well almost 10 years after LT.
Conclusion:
LT for diffuse massive HH, although exceptionally rare, is feasible in selected adults. The modified left-to-right piggyback technique is useful to overcome intraoperative difficulties that may arise due to massive hepatomegaly.
