Urgency surgical treatment for ruptured hepatic adenoma: experience of 23 years

Abstract

Background: Hepatocellular adenoma (HA) is a benign tumor, which mainly affects young women using oral contraceptives, usually presenting as a single nodule. The clinical picture varies from abdominal pain in the epigastrium and right hypochondrium with palpable mass to asymptomatic or by one of its complications, such as malignancy or rupture. When ruptured, it may present with acute abdominal pain, which may lead to intrahepatic or intraperitoneal bleeding with or without signs of hypovolemic shock. If the patient remains hemodynamically unstable despite adequate volume resuscitation, immediate surgical intervention is necessary, recommending principles of damage control of hepatic trauma, aiming at adequate hemostasis, hepatectomy in this situation is a procedure associated with considerable morbidity and mortality. Methods: Analyze the epidemiology, risk factors and surgical treatment of HA with rupture (RHA) in University of Campinas in a last 22 years. The records of the patients with confirmed pathology of RHA submitted to surgery on University of Campinas from 1995 to 2017 were retrospectively evaluated. The diagnosis of HA was confirmed by the histology being categorized by the presence or absence of Rupture by clinical signs or radiological findings. Results: There were 28 cases of HA submitted to surgery, of which 8 RHA (28.57%), the mean age was 35.05 years, 7 were female and 1 male. Five of these patients used oral contraceptives. Mean intraoperative bleeding was 3084.5 ml, with 3 deaths occurring. Conclusion: RHA may or may not be associated with hemodynamic instability, a potentially life threatening condition, mainly associated with lesion size and OAC use. In centers where interventional radiology is not available surgical treatment is indicated to control bleeding and stabilize the patient with high morbidity and mortality.