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Hepatic hemangioma in childhood: medical management or surgical management?
Insights
Liver hemangiomas in infants often resolve spontaneously within the first year of life. Non-operative management is recommended for asymptomatic cases, reserving surgery for complications.
Area of Science:
- Pediatric Surgery
- Hepatology
- Neonatal Care
Background:
- Liver hemangiomas are vascular tumors that can present in infancy.
- Massive hepatomegaly is a common initial clinical sign.
- Complications include anemia and cardiac failure.
Purpose of the Study:
- To review the clinical course and management of infantile liver hemangiomas.
- To evaluate the outcomes of different treatment strategies.
- To establish guidelines for optimal patient management.
Main Methods:
- Retrospective review of 14 patients treated between 1955 and 1980.
- Analysis of clinical presentation, diagnostic methods, and treatment interventions.
- Long-term follow-up to assess outcomes and symptom resolution.
Main Results:
- All 14 patients presented with massive hepatomegaly, often in the neonatal period.
- Two patients experienced cardiac failure, and six developed anemia requiring transfusion.
- Tumor involution occurred within the first year of life in all cases.
- A shift in management from surgical intervention to symptomatic, non-operative treatment was observed after 1976.
Conclusions:
- Infantile liver hemangiomas typically involute spontaneously within the first year.
- Asymptomatic cases do not require active treatment; steroids and radiotherapy are not indicated.
- Non-operative management is effective for anemia and cardiac failure.
- Surgical intervention is reserved for refractory cases or rupture.
Abstract:
Between 1955 and 1980 there were 14 patients treated at The Hospital for Sick Children with hemangiomas of the liver. Eight were seen at birth and 13 within the first 6 wk of life. The presenting clinical feature was that of massive hepatomegaly. Two children who had presented in the neonatal period were found to have had cardiac failure. Six patients were anemic and required blood transfusions. Before 1976 all patients who did not have cutaneous hemangiomas underwent laparotomy. Since 1976 only one laparotomy was done, the remaining 5 patients all having been treated symptomatically without operation. All the tumors involuted in the first year of life. Follow-up ranged from 1 to 20 yr and all are living and without symptoms. We recommend no active treatment if complications are absent. Steroids and radiotherapy are not used. If anemia and/or cardiac failure supervene, appropriate nonoperative management is necessary. Surgical treatment is indicated only if medical management fails or for rupture of the lesion.