Gnanasekar, M (2014) Giant Hepatic Hemangiomas - analysis of presentation, management and outcome : A Single Center experience. Masters thesis, Madras Medical College, Chennai.
|
Text
180600114gnanasekar.pdf Download (2MB) | Preview |
Abstract
BACKGROUND : Hemangiomas represents a congenital, hamartomatous proliferation (Non-neoplastic) of vascular origin, arising from mesodermal layer. Its etiology emains idiopathic, with the liver being the most common visceral organ affected. Majarity of the cases are of a incidental discovery rather than a attempted search for the lesion. Therefore the natural history of the Hemangioma are often asymptomatic and persists throughout the lifespan of the patient. Only less than 10% of the lesions become symptomatic, and come for clinical attention. Within this a small percentage can meet with complications, particularly in those where the lesion is quite large, of the order of more than 10cm. Management options are varied ranging from simple observation to interventions like resection, eunucleation, hepatic artery ligation and liver transplantation ,besides non operative procedures like angio embolisation, radiation therapy, and recently molecular target agents like Sorafenib , bevacizumab and so on . AIM : To study the different modes of presentation, gender predilection, symptomatology, complications, various management modalities, outcome of the varsious treatment strategies, in patients with Giant Cavernous symptomatic Hepatic Hemangioma ,who were admitted in our center, between march 2012 to 2014. MATERIALS AND METHODS : Only those cases of hemangioma liver who were persistenly symptomatic,and those presenting with complications , were included in this retrospective analysis. A total of eleven such patients were listed in this series(2012 -2014). Asymptomatic ,incidentally diagnosed hemangioma liver were excluded from this analysis. Variables analysed in this study: Gender differences, Average size, Predominant symptom, Imaging modality employed, Predominant mode of intervention (resection or eunucleation anatomical or nonanatomical resection) ,Morphology of the tumour, Peroperative and Post operative parameters, Duration of post operative stay and Mortality were analysed in this study. RESULTS : Age incidence in this analysis ranged between 22 and 60 yrs, with a median age of 40 yrs. Predominantly occurring in the female gender (90.9%), but no chronic OCP usage, or any exogenous hormonal intake were found in this study. Majority of the lesions were in the Lt lobe (66.66%), supporting the fact that lesions in the left lobe are often symptomatic. Besides this finding, there is a linear relationship between size and symptoms in this analysis, with over 90% of the patients becoming symptomatic when the lesion is over 15 cm. And moreover pain abdomen was found to be the predominant symptom which made the patient to seek medical attention in this study. All were diagnosed with imaging alone, with CECT being the predominant diagnostic imaging in our series . As far as the treatment strategy is concerned, all the patients were persistently symptomatic and therefore deserved intervention. Ten out of eleven patients (10/11 patients) underwent surgery, either alone or with combined modality like angioembolisation, or Sorafenib therapy, particularly for a patient who was harbouring a lesion of size (37x19x15cm), in her right lobe. Amongst the surgical options, resection and not enucleation, was the surgical modality employed in this series. The reason being that we could find no well defined plane of cleavage between the liver parenchyma and the lesion in any of the patients that we operated. For those surgically high risk group, mere angio embolisation alone could be an safe alternative, which we offered as a sole management in a patient who presented with tumour rupture. Angioembolisation stopped the bleeding. Literature also reports no increase in size or any malignant transformation in the lesions that were left behind as remnants after such therapy. Resection in this series varied between a simple stapled hepatic resection where the operative blood loss and the duration of surgery were very minimal (0.07 litre blood loss, 2hrs 15min.) to major resection utilizing thoracoabdominal access in the form of median sternotomy, interpericardiac IVC control, (requiring about 14 units of blood, 4.2 litres blood loss and taking 7 hour long surgery). Mortality in this analysis is a patient wherein the liver is found to be fatty and after resection, bled from the remnant raw area, wherein we tried with perihepatic packing, but subsequently she succumbed to multiorgan dysfunction after second look lapatrotomy, even though raw area has stopped its bleeding. CONCLUSION : Hemangioma liver can sometimes be therauptically very challenging. Even though the indications for intervention are clear ,the choice of the various management options must be tailored to the patient’s clinical condition and the expertise availability. Complications that can occur in hemangioma may be life endangering too, sometimes demanding multidisciplinary approach. Offering surgery for those patients requires a great deal of knowledge and experience in liver resection and requires a well equipped center with multidisciplinary personnels for successful outcome in the management of these patients.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Giant Hepatic Hemangiomas ; analysis ; presentation ; management ; outcome ; Single Center experience. |
| Subjects: | MEDICAL > Surgical Gastroenterology and Proctology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 27 Jul 2017 03:44 |
| Last Modified: | 27 Jul 2017 05:02 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2220 |
Actions (login required)
 |
View Item |
