Successful enucleation of a giant hepatic hemangioma occupying segments II, III, IVA, and IVB: a case report

Background: Hepatic hemangioma is the most common benign liver tumor and is often asymptomatic and incidentally discovered. Although most smaller lesions remain asymptomatic and only require conservative monitoring, giant hepatic hemangiomas may cause abdominal pain, early satiety, and compression of adjacent structures. Surgical resection or enucleation is indicated as the definitive treatment for symptomatic patients, rapidly enlarging lesions, or diagnostically uncertain cases in which malignancy cannot be excluded. We report a surgical case of a 15 × 10 × 12 cm giant hepatic hemangioma successfully treated with enucleation. Case presentation: A 49-year-old woman presented with progressive abdominal distention that had been ongoing over the past 5 years. Contrast-enhanced computed tomography and magnetic resonance imaging demonstrated a 15 × 10 × 12 cm giant hepatic hemangioma occupying liver segments II, III, IVA, and IVB. Given the lesion’s notable size and the degree of distention, the patient underwent an open enucleation with cholecystectomy because of the tumor’s contact with the gallbladder bed. The postoperative course was uneventful, and the patient recovered without complications. Conclusion: This case demonstrates the safety and effectiveness of enucleation as a parenchyma-sparing option for symptomatic, large multi-segmental liver hemangiomas. Complete removal with excellent postoperative outcomes can be achieved through adequate operative planning.