Treatment of ruptured hepatocellular adenoma.
BACKGROUND
As the morbidity and mortality rates associated with emergency resection in patients with a ruptured hepatocellular adenoma are high, the authors have favoured initial non-operative management in haemodynamically stable patients.


METHODS
A retrospective study was performed to evaluate the treatment of ruptured hepatocellular adenoma.


RESULTS
Over a 21-year interval, 12 patients presented with a ruptured hepatocellular adenoma. Haemodynamic observation and support was the initial management in all 12 patients. Three underwent urgent laparotomy and gauze packing because of haemodynamic instability; no emergency liver resection was necessary. Eight patients had definitive surgery; three developed postoperative complications but none died. Regression of the tumour was observed in three of four patients treated conservatively.


CONCLUSIONS
The initial management of a ruptured hepatocellular adenoma should be haemodynamic stabilization. Definitive resection is required for rebleeding or for tumours exceeding 5 cm in diameter. A conservative approach may well be justified in case of regression of an asymptomatic adenoma.
Terkivatan
T
T
Department of Surgery, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands.
de Wilt
J H
JH
de Man
R A
RA
van Rijn
R R
RR
Tilanus
H W
HW
IJzermans
J N
JN
D018248:Adenoma, Liver Cell / Q000601:surgery*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000601:surgery