What is the incidence of spontaneous or traumatic rupture of a giant hepatic (liver) hemangioma?

From the Guidelines

The incidence of spontaneous or traumatic rupture of a giant hepatic hemangioma is approximately 3.2% for lesions larger than 4 cm, and increases to 5% for lesions larger than 10 cm. This condition is a significant concern due to its potential for severe morbidity and mortality. According to a retrospective cross-sectional study of 2,071 patients 1, the risk factors for rupture include the size and location of the hemangioma, with peripherally located and exophytic lesions being at higher risk.

• Key factors influencing the risk of rupture include:
  • Size of the hemangioma: Lesions larger than 10 cm have a higher risk of rupture, approximately 5% 1.
  • Location of the hemangioma: Peripherally located and exophytic lesions are at increased risk of rupture 1.
• Management of giant hepatic hemangiomas typically involves conservative monitoring, but in cases of rupture or rapid enlargement, resection may be necessary, even during pregnancy 1.
• It is essential to consider the merits of treatment prior to conception in cases of giant hepatic hemangiomas, especially those larger than 10 cm, to minimize the risk of complications 1.

From the Research

Incidence of Spontaneous or Traumatic Rupture of a Giant Hepatic Hemangioma

• The incidence of spontaneous rupture of a giant hepatic hemangioma is estimated to be around 1-4% 2.
• A study found that out of 32 cases of spontaneous rupture of hepatic hemangioma in adults, 16 (84.2%) had giant hemangiomas with a mean diameter of 14.8 cm 3.
• Another study reported a case of giant hepatic hemangioma presenting as hemoperitoneum following traumatic rupture, highlighting the risk of rupture in these tumors 4.
• The risk of spontaneous rupture is higher in giant hemangiomas, with one study estimating a risk of 3.2% in giant hemangiomas, particularly when peripherally located and exophytic 5.
• Spontaneous rupture is a rare but catastrophic complication of hepatic hemangioma, with a high mortality rate if not promptly managed 6.

Risk Factors for Rupture

• Giant size (diameter of 4 cm or more) is a significant risk factor for rupture 3, 5.
• Exophytic lesions are more likely to rupture than centrally located tumors 5.
• Trauma can also trigger rupture of a giant hepatic hemangioma 4.

Management of Ruptured Giant Hepatic Hemangioma

• Preoperative transcatheter arterial embolization (TAE) can significantly improve outcome in patients with spontaneous rupture of giant hepatic hemangioma 3, 6.
• Surgery, including resection or tamponade, may be necessary to control bleeding and prevent re-bleeding 2, 3.
• The choice of management depends on the individual case and the presence of other complications 2, 6.