Elective Laparoscopic Resection Following Transarterial Embolization and Anticoagulation for a Giant Hepatocellular Adenoma with Hemorrhage and Venous Thrombosis: A Case Report.

INTRODUCTION

Hepatocellular adenoma (HCA) is a rare benign liver tumor that can be complicated by hemorrhage, whereas concomitant major venous thrombosis is uncommon.

CASE PRESENTATION: A 25-year-old woman presented with epigastric pain and nausea. Contrast-enhanced CT showed a 17-cm liver tumor involving the anterior and medial segments, which suggested HCA with intratumoral hemorrhage. She initially underwent transarterial embolization (TAE) for hemostasis at a previous hospital. Subsequent CT showed thrombi in the inferior vena cava and pulmonary artery, and she was referred to our institution. On the basis of her stable condition and the presumed benign nature of the tumor, anticoagulation therapy was initiated to treat the thromboses, and elective surgery was planned. After 8 months, the thrombi had resolved, and the tumor had decreased in size. Laparoscopic central bisectionectomy was then successfully performed. The postoperative course was uneventful, and the patient was discharged on POD 8.

CONCLUSIONS

In patients with a large HCA complicated by hemorrhage and venous thromboses, a staged approach consisting of TAE and anticoagulation may enable safe and minimally invasive elective laparoscopic hepatectomy.