Spontaneous rupture of liver hemangioma during pregnancy

Background: Cavernous hemangioma is the most common benign tumor of the liver. Autopsy series have revealed an incidence of 0.4–20%. Liver hemangiomas undergo rupture extremely rarely. Up to 1993, the number of reported cases of ruptured hemangiomas during pregnancy in the world literature was only 28; in the last decade, merely sporadic cases have been reported. The rate of mortality associated with such ruptures in adults is very high.

Case: A 31-year-old patient in the 38th week of pregnancy was urgently hospitalized because of chest pain, a fainting feeling and hypotension. Lactacidosis, hyperglycemia and anemia were found. Fetal heart sounds could not be observed. With a diagnosis of intraabdominal bleeding, laparotomy was performed urgently. The source of the bleeding proved to be a ruptured liver hemangioma. This bleeding was stopped primarily by packing, and Cesarean section was carried out. The fetus had already died before the intervention. Rebleeding necessitated liver resection.

Conclusion: Patients with asymptomatic hemangiomas do not normally require surgery, because their spontaneous rupture is rare and a malignant change is unlikely. The size of the hemangioma is not a criterion for excision. From the present instructive case report, the lesson can be drawn that sonography on several occasions during pregnancy should be supplemented by abdominal ultrasonography. The gynecologist can then be prepared for this unusual complication. Without an exact diagnosis in an emergency situation, definitive surgical treatment can not be provided in all cases. Early diagnosis and adequate therapy may have preserved the life of the fetus.