title: Treatment of ruptured hepatocellular adenoma.
abstract: 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.
authors.affiliation: Department of Surgery, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Terkivatan
authors.forename: J H
authors.initials: JH
authors.lastname: de Wilt
authors.forename: R A
authors.initials: RA
authors.lastname: de Man
authors.forename: R R
authors.initials: RR
authors.lastname: van Rijn
authors.forename: H W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: J N
authors.initials: JN
authors.lastname: IJzermans
mesh_terms: 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