Giant hemangioma of the liver presenting with abdominal compartment syndrome: a case report

BACKGROUND: Hemangiomas are the most common liver neoplasms and are usually detected incidentally. Most cases are asymptomatic and observation is sufficient. Treatment is required for giant hemangiomas (>4 cm) if they are symptomatic and demonstrate rapid progression in size or when there is doubt in diagnosis. Giant hemangiomas may sometimes be responsible for consumptive coagulopathy and congestive cardiac failure. However, these complications are rare in adults compared with children. METHODS: We report the first case of a giant hemangioma of the liver presenting with abdominal compartment syndrome that was treated by surgery. RESULTS: A middle-aged woman presented with a symptomatic giant hemangioma involving segments 5–8 of the liver. She was advised to undergo surgery but opted for angiographic embolization instead. After transient relief which lasted for 2 months, the hemangioma started to increase in size. Six months post embolization she was readmitted with the hemangioma increased (now involving segments 4–8) and features of abdominal compartment syndrome. After the risks were explained, she was operated upon and underwent a right trisectionectomy. The specimen weighing 8.5 kg on histology revealed a cavernous hemangioma with areas of hemorrhage and necrosis. The patient had an uneventful postoperative course. CONCLUSIONS: Giant hemangioma is an unusual cause of abdominal compartment syndrome. These patients can be successfully managed by major liver resection if proper surgical techniques are used.