From the Guidelines
The incidence of rupture in giant hepatic hemangiomas is approximately 3.2% for lesions larger than 4 cm, and up to 5% for those larger than 10 cm. Giant hepatic hemangiomas are defined as benign liver tumors composed of blood vessels that exceed 4 cm in diameter 1. Despite their large size, these lesions rarely rupture spontaneously. When rupture does occur, it typically presents as acute abdominal pain and can lead to life-threatening intraperitoneal hemorrhage requiring emergency intervention. Risk factors that may increase the likelihood of rupture include rapid growth, superficial location (especially in the left lobe), pregnancy, and trauma to the abdomen. The rupture rate is attributed to the hemangioma's characteristics, such as peripheral location and exophytic lesions, which increase the risk of rupture 1. Most giant hemangiomas are managed conservatively with observation unless they cause symptoms or complications.
Some key points to consider in the management of giant hepatic hemangiomas include:
- The risk of rupture increases with the size of the lesion, with lesions larger than 10 cm having a higher risk of rupture 1
- Peripheral location and exophytic lesions are associated with a higher risk of rupture 1
- Pregnancy may increase the risk of rupture due to accelerated growth, increased intra-abdominal pressure, and direct contact with the gravid uterus 1
- Close monitoring is recommended for patients with giant hepatic hemangiomas, especially those with larger lesions or other risk factors for rupture 1
In terms of management, conservative management with observation is usually sufficient, unless the patient experiences symptoms or complications. Resection may be considered in cases of rapidly enlarging lesions or those complicated by rupture 1. It is essential for clinicians to understand the risks and management options for giant hepatic hemangiomas to provide appropriate counseling and care for patients with these common benign liver lesions.
From the Research
Incidence of Rupture of Giant Hepatic Haemangiomas
- The incidence of rupture of giant hepatic haemangiomas is estimated to be around 1-4% 2.
- Spontaneous rupture is a severe complication that can occur in giant liver hemangiomas, with a high mortality rate of about 60% 2.
- The risk of rupture is unpredictable, and there are no clear risk factors identified for spontaneous rupture of liver hemangiomas 2.
Treatment and Management
- Treatment options for giant hepatic hemangiomas include observation, surgical resection, and transcatheter arterial embolization (TAE) 3, 4, 5.
- Surgical resection is usually limited to symptomatic tumors larger than 10 cm 2.
- TAE is a useful procedure in stopping bleeding and can be used as a bridge to surgery or as a primary treatment for symptomatic hemangiomas 4, 5.
- Transarterial chemoembolization has also been used as a primary treatment for super-giant hepatic hemangiomas 6.
Complications and Outcomes
- Postoperative complications are associated with large tumor size, symptomatic tumors, and greater use of intraoperative inflow control 3.
- Most complications can be treated conservatively, but invasive interventions may be required for management of grade III complications 3.
- The use of TAE and surgical resection can improve outcomes in patients with spontaneous rupture of giant hepatic hemangiomas 5.