title: The risk of spontaneous rupture of liver hemangiomas: a critical review of the literature.
abstract: BACKGROUND
  The risk of spontaneous bleeding or rupture of liver hemangiomas still remains unknown. The aim of this review was to analyze the problem of spontaneous bleeding or rupture in liver hemangiomas and to identify factors leading to bleeding in these cases.
  
  
  METHODS
  A MEDLINE search was undertaken to identify articles in English, French, German, Italian, and Spanish from 1898 to 2010. Basic data such as age and sex of patients were collected. Additional data such as risk factors or causes of rupture were also analyzed. Cases were divided into spontaneous and non-spontaneous ruptures.
  
  
  RESULTS
  A total of 97 cases are described. In 51 of the 97 patients (52.6%) a non-spontaneous rupture was identified. Only in 46 out of the 97 cases (47.4%) was a spontaneous rupture found. Non-spontaneous rupture was significantly more frequent in patients aged <40 years than in older ones (p = 0.0099). Mean size of the ruptured lesions was 11.2 cm (range 1-37 cm). Massive bleeding occurred in 88 patients (90.7%). Reported mortality over the past 20 years has been significantly lower than before (p < 0.001). The overall mortality for the period under study was ~35%.
  
  
  CONCLUSIONS
  The spontaneous rupture of a hepatic hemangioma is to be considered an exceptional event. Preventive surgery should be considered only for lesions of at least 11-cm size in special cohorts of patients.
authors.affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Asklepios Medical School, Rübenkamp 220, Hamburg, Germany. mar_donati@libero.it|Department of Surgical Science, Organ Transplants and New Technologies, General Surgery and Week Hospital, University Hospital of Catania, Catania, Italy. mar_donati@libero.it.
authors.forename: Marcello
authors.initials: M
authors.lastname: Donati
authors.affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Asklepios Medical School, Rübenkamp 220, Hamburg, Germany.
authors.forename: Gregor A
authors.initials: GA
authors.lastname: Stavrou
authors.affiliation: Department of Surgical Science, Organ Transplants and New Technologies, General Surgery and Week Hospital, University Hospital of Catania, Catania, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Donati
authors.affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Asklepios Medical School, Rübenkamp 220, Hamburg, Germany.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Oldhafer
mesh_terms: D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006391:Hemangioma / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications*; D012307:Risk Factors; D012422:Rupture, Spontaneous