From the Guidelines
The incidence of rupture of giant hepatic hemangiomas in non-pregnant individuals is approximately 3% for lesions larger than 4 cm in diameter, as reported in a recent study 1. Giant hepatic hemangiomas are benign vascular tumors of the liver that are typically asymptomatic and often discovered incidentally during imaging studies. Despite their large size, these lesions have a relatively low risk of spontaneous rupture in the absence of trauma or other precipitating factors. The risk of rupture is associated with the size of the hemangioma, with larger lesions (>4 cm) having a higher risk of rupture, as well as peripherally located and exophytic lesions 1. In non-pregnant individuals, the risk of rupture is lower compared to pregnant women, where hormonal influences and increased abdominal pressure may contribute to a higher risk of rupture. However, even in non-pregnant individuals, rupture can occur and may present as acute abdominal pain, leading to life-threatening intraperitoneal hemorrhage requiring emergency intervention. Key factors that increase the risk of rupture include:
- Size of the hemangioma, with lesions larger than 4 cm having a higher risk
- Peripheral location of the hemangioma
- Exophytic lesions
- Presence of trauma or other precipitating factors Given the potential risks, close monitoring of giant hepatic hemangiomas in non-pregnant individuals is recommended, particularly for lesions larger than 4 cm in diameter, to promptly identify any changes that may indicate an increased risk of rupture 1.
From the Research
Incidence of Rupture of Giant Hepatic Hemangiomas
- The incidence of rupture of giant hepatic hemangiomas is reported to be rare, with a mortality rate of 36-39% 2.
- Spontaneous rupture of a giant hemangioma of the liver is a severe complication that can occur in 1-4% of hemangiomas 3.
- The exact incidence of rupture in non-pregnant individuals is not specified in the provided studies, but it is mentioned that rupture is a rare but potentially lethal complication 4, 5.
Risk Factors and Treatment
- The absence of risk factors for spontaneous rupture of liver hemangiomas makes this event unpredictable 3.
- Surgical resection is indicated in patients with abdominal complaints or complications, or when diagnosis remains inconclusive 2.
- Preoperative transcatheter arterial embolization (TAE) can significantly improve outcome in patients with spontaneous rupture of giant hepatic hemangiomas 4, 5.
- Enucleation is the preferred surgical method for giant liver hemangiomas, according to existing literature and experience 2.
Management and Outcomes
- Observation is justified in the absence of symptoms in patients with giant liver hemangiomas 2.
- Sequential treatment with preoperative TAE and conservative hepatectomy can be an effective management strategy for spontaneous rupture of giant hepatic hemangiomas 4, 5.
- The use of TAE can improve outcomes and reduce operative morbidity and mortality in patients with bleeding ruptured liver tumors and non-operative treatment of symptomatic giant liver hemangiomas 4, 5.