title: Surgical management of spontaneous ruptured hepatocellular adenoma.
abstract: OBJECTIVE
  Spontaneous ruptured hepatocellular adenoma (SRHA) is a rare life-threatening condition that may require surgical treatment to control hemorrhaging and also stabilize the patient. We report a series of emergency surgeries performed at our institution for this condition.
  
  
  METHODS
  We reviewed medical records and radiology files of 28 patients (from 1989 to 2006) with a proven diagnosis of hepatocellular adenoma (HA). Three (10.7%) of 28 patients had spontaneous ruptured hepatocellular adenoma, two of which were associated with intrahepatic hemorrhage while one had intraperitoneal bleeding. Two patients were female and one was male. Both female patients had a background history of oral contraceptive use. Sudden abdominal pain associated with hemodynamic instability occurred in all patients who suffered from spontaneous ruptured hepatocellular adenoma. The mean age was 41.6 years old. The preoperative assessment included liver function tests, ultrasonography and computed tomography.
  
  
  RESULTS
  The surgical approaches were as follows: right hemihepatectomy for controlling intraperitoneal bleeding, and right extended hepatectomy and non-anatomic resection of the liver for intrahepatic hemorrhage. There were no deaths, and the postoperative complications were bile leakage and wound infection (re-operation), as well as intraperitoneal abscess (re-operation) and pleural effusion.
  
  
  CONCLUSIONS
  Spontaneous ruptured hepatocellular adenoma may be treated by surgery for controlling hemorrhages and stabilizing the patient, and the decision to operate depends upon both the patient's condition and the expertise of the surgical team.
authors.affiliation: Department of Gastroeneterology, Liver and Portal Hypertension Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil. mribeiro@cwaynet.com.br
authors.forename: Marcelo Augusto Fontenelle
authors.initials: MA
authors.lastname: Ribeiro Junior
authors.forename: Eleazar
authors.initials: E
authors.lastname: Chaib
authors.forename: William Abrão
authors.initials: WA
authors.lastname: Saad
authors.forename: Luiz Augusto Carneiro
authors.initials: LA
authors.lastname: D'Albuquerque
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D018248:Adenoma, Liver Cell / Q000150:complications / Q000601:surgery*; D000328:Adult; D004638:Emergency Treatment; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous / Q000601:surgery; D016896:Treatment Outcome
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