title: Management of spontaneous haemorrhage and rupture of hepatocellular adenomas. A single centre experience.
abstract: BACKGROUND
  Hepatocellular adenomas (HCA) may present with spontaneous haemorrhage and rupture. The aim of this study was to assess management in 22 patients treated for haemorrhage and/or rupture of HCA.
  
  
  METHODS
  Between May 1990 and July 2005, 22 female patients were diagnosed with acute haemorrhage and/or rupture of lesions highly suspicious of HCA. Preoperative imaging diagnostics and pathologic specimens were reviewed.
  
  
  RESULTS
  Twelve haemodynamically stable and four unstable patients could be treated conservatively. One patient underwent acute partial liver resection, whereas four patients underwent laparotomy with initial packing of the liver. In one patient, selective embolisation of the left hepatic artery was performed. Fifteen patients eventually underwent resection after a mean time of 8 months after initial treatment. Six patients did not undergo resection and showed no complications or rebleeding after a mean follow-up of 24.6 months. Only in seven patients, histopathological examination showed HCA, and in one patient, HCA with focal nodular hyperplasia.
  
  
  CONCLUSIONS
  HCA with haemorrhage and/or rupture does not necessarily require immediate liver resection. Conservative treatment is justified in stable patients. In case of an instable patient with or without hemoperitoneum, laparotomy with packing or selective embolisation can stop the bleeding.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Deha
authors.initials: D
authors.lastname: Erdogan
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Otto M
authors.initials: OM
authors.lastname: van Delden
authors.forename: Fiebo J W
authors.initials: FJ
authors.lastname: Ten Kate
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
mesh_terms: D018248:Adenoma, Liver Cell / Q000150:complications* / Q000473:pathology; D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D012421:Rupture; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome