Enucleation plus caudate lobe resection for central giant hemangioma of the liver

Abstract

Background: Hepatic hemangiomas warrant therapy if they are causing significant symptoms or are increasing in size. Enucleation is easier and safer than partial hepatectomy. Giant centrally located lesions are more challenging but can be treated with the same approach. Methods: A 70 years old man was referred to our hospital for pain in the right upper abdomen. CT scan revealed a central giant liver hemangioma compressing the cava and the suprahepatic veins with fissuration on segment 8. No signs of active bleeding were detected. The right diaphragm was elevated with concomitant right basal effusion and pneumonia. The size of the hemangioma was significantly increased in comparison with a previous exam taken 4 years before (main diameter from 9 to 12 cm). Patient was monitored after admission and surgey was delayed until the resolution of the pneumonia. Results: Resection of the caudate lobe and enucleation of the giant hemangioma under intermittent clamping was performed. After the caudate lobe was dissected from the caval vein the plan of dissection followed the capsule of the hemangioma to complete the enucleation from the surrounding parenchyma and the suprahepatic veins. Patient did't require transfusion. Postoperative course was uneventful and the patient was discharged 5 days after operation. Conclusion: Combined resection and enucleation is feasible also for centrally located giant hemangioma and need to be considered the safest approach when surgery become mandatory. It avoids complex liver resections.