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Torsion of pedunculated hepatic hemangioma in a 2-month-old boy.
Olga Karaseva, Anna Timofeeva, Ilia Melnikov, Alexander Bryantsev
Clinical and Research Institute of Emergency Pediatric Surgery and Trauma - Dr. Roshal's Clinic
Introduction:Hemangiomas are most common benign hepatic tumors. In the world published English literature, only 39 cases of pedunculated liver hemangiomas are described, with only one case in a child.
Aim:To present a clinical case of torsioned pedunculated hepatic hemangioma in an infant and to show the difficulties we faced with during diagnosis.
Materials and methods:A 2-month-old boy admitted with stool retention, abdomen tense and complaints on discomfort. He was hospitalized with suspected intestinal intussusception. The diagnostic stage included laboratory tests, X-ray, ultrasound, CT of the abdomen.
Results:Severe anemia (Hb=68g/L) and hypoproteinemia (total protein=39.2g/L, albumin=22.4g/L) were diagnosed. On plain abdominal X-ray signs of bowel obstruction were seen. On US of the abdomen in the left hypochondriac region a mass 60x19mm with single pixels of blood flow was visualized (conclusion:mass lesion of the spleen). Abdominal CT: in left subphrenic space ovoid shape tumor mass of size 45x48x42mm, with heterogeneous structure and mild contrast enhancement was diagnosed. Diagnostic laparoscopy was performed: torsion and necrosis of the accessory spleen was suspected. Conversion to left subcostal oblique laparotomy was made. A mass lesion on thin torsioned peduncle coming from left lobe of the liver was seen. Using US-dissector a peduncle was transected. Drain tube was placed in the abdomen. The postoperative diagnose was: liver mass lesion torsion. Postoperative period was uneventful, the drainage was removed on POD2, the child was discharged on POD6 in satisfactory condition. Histological examination verified hemangioma with total hemorrhagic necrosis and massive hemorrhages.
Conclusion:A rare form of liver hemangioma, complicated by torsion, in an infant is presented. The cause of abdominal pain syndrome could be verified only intraoperatively despite the complex of examinations performed. This is the second described case in the World of torsioned pedunculated liver hemangioma in an infant.