Spontaneously ruptured hepatic hemangioma: A case study and comprehensive review of the literature

Hepatic hemangiomas are benign vascular malformations thought to be of congenital origin. They are typically solitary, small, and asymptomatic. In rare cases, large tumors spontaneously rupture. We present the case of a 29-year-old female who presented with acute onset abdominal pain and nausea. Abdominal imaging showed a large mass in the liver demonstrating progressive nodular enhancement. Further imaging showed free fluid in the pelvis. A diagnostic laparoscopy was followed by an open left lateral hepatic segmentectomy. Pathology confirmed benign hemangioma. Signs and symptoms of spontaneously ruptured hepatic hemangiomas are often nonspecific. MRI is the most sensitive and specific imaging modality for diagnosing hepatic hemangiomas; however, determination of rupture requires clinical suspicion. Management is focused on maintaining hemodynamic stability and addressing the source with resection, enucleating, or embolizing the tumor. A literature review of 34 other cases revealed a mortality rate of 9 %, demonstrating a significant improvement compared to prior studies. The improvement in mortality is attributable to advancements in surgical techniques, critical care, resuscitation of unstable patients, pharmacologic safety profiles, postoperative care, and imagining modalities. In conclusion, spontaneous rupture of hepatic hemangiomas is a rare and life-threatening event. Hepatic resection remains the mainstay of treatment; although, transcatheter arterial embolization offers a minimally invasive route to control bleeding, shrink the hemangioma, and stabilize the patient.