Emergency Single Incision Laparoscopic Liver Resection (SILL) in ruptured Liver Adenoma: a Case Report

Abstract

Background: Spontaneous rupture of liver tumors, such as hepatocellular adenoma (HCA) and carcinoma (HCC), is rare but might lead to a potentially life-threating situation, as unspecific symptoms can be misleading. However, immediate interventional or surgical intervention is required to stop the bleeding. Methods: A female 53-year old patient was admitted to the hospital with unspecific epigastric pain for the past three days. Successful emergency angiographic embolization was accomplished with gelatin foam powder in the hemodynamically stable patient. Subsequent magnetic imaging (MRI) revealed the most likely diagnosis of an HCA, which had ruptured and a two additional adenomas witch less than 3cm in diameter in segments 4 and 6. We performed a single-incision laparoscopy to evacuate the hematoma and to address the ruptured liver tumor. Anatomical left lateral sectionectomy was performed. The resected liver lobe was removed via the umbilical single-port incision. Results: The postoperative course was uneventful and the patient could be discharged on postoperative day 5. Conclusion: With the high probability of a benign lesion to be resected at the site of rupture and the additional lesions without an immediate indication for surgical removal, it was safe to perform the resection laparoscopically instead of a major open resection. In our opinion, benefits of routine laparoscopic liver surgery should also be taken into account in emergency settings.