Giant hepatic hemangioma presenting with atypical gastrointestinal symptoms: a case report

Introduction: Hepatic hemangiomas are the most common benign liver tumors, accounting for approximately 73% of all benign hepatic neoplasms. Giant hemangiomas (>4–5 cm) may cause mass-effect symptoms; resection is indicated when medical or interventional therapies fail. Case presentation: A 32-year-old woman with no prior medical history presented with gastrointestinal (GI) discomfort, postprandial vomiting, and dyspepsia unresponsive to proton pump inhibitors, along with early satiety and a 3 kg weight loss over 6 months. Examination revealed a firm, non-tender right upper quadrant mass 8 cm below the costal margin. Computed tomography and magnetic resonance imaging demonstrated a 20 cm hypervascular liver mass involving segments 5, 6, and 7, consistent with a giant hepatic hemangioma. Laboratory findings were within normal limits. She underwent an open right hepatectomy, preserving segment 8 and resecting segments 5–7, with an intermittent Pringle maneuver (25 minutes total clamp time). An enhanced recovery after surgery protocol was implemented, and the postoperative course was uneventful; the patient was discharged on postoperative day 2. Histopathology confirmed cavernous hemangioma. Discussion: This case highlights a giant hemangioma (20 cm) presenting with non-specific GI symptoms rather than classic manifestations. While most giant hemangiomas are managed conservatively when asymptomatic, this patient’s progressive symptoms attributable to mass effect warranted surgical intervention. Segmental resection achieved complete symptom relief. Conclusion: Giant hepatic hemangiomas can reach 20 cm and present with only vague GI symptoms. Segmental resection with the Pringle maneuver is safe and effective in symptomatic patients, yielding excellent outcomes.