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Abstract: Hepatic hemangioma is a common liver tumor in clinical practice, mostly benign, and is often detected during physical examination or surgery. In this patient, the presence of hepatic hemangioma was found during physical examination, but the tumor appeared to be significantly enlarged later due to long-term oral contraceptive use. A sudden and unexpected car accident caused the patient’s hepatic hemangioma to rupture, resulting in hemorrhage and hemorrhagic shock. After active resuscitation and timely partial resection of the right liver, the bleeding was finally controlled, and the patient turned critical and was discharged successfully.
Basic information】Female, 28 years old
Disease Type】Hepatic rupture, hepatic hemangioma rupture, hemorrhagic shock
Hospital】Associated Hospital of Fujian Medical University
Date of Consultation】September 2021
Treatment plan】Surgical treatment (dissection + partial right hepatectomy)
Treatment Period】Inpatient treatment for more than 1 month
Treatment effect] The bleeding was controlled, and the patient was discharged from the hospital.
I. Initial consultation
Three years ago, a hepatic hemangioma was found in the patient’s body during a physical examination, but the tumor was small at that time, only 5mm. After consulting with the doctor, the patient learned that the growth of the hemangioma was probably caused by the long-term use of oral contraceptives in daily life. Since the estrogen in the drug may have the risk of stimulating the growth of hepatic hemangioma, the patient began to learn about the results of this test. Upon learning of this test result, the patient became anxious and upset and had an argument with her boyfriend on the phone, which resulted in a car accident while driving and a liver rupture, and the patient’s hepatic hemangioma happened to be located at the rupture site, resulting in heavy bleeding. When the patient was brought to our hospital, he already showed signs of confusion and shock. Physical examination showed massive abdominal bleeding and extremely low hematocrit, and the clinical diagnosis was hepatic rupture and ruptured hepatic hemangioma with hemorrhagic shock.
(The previous hepatic hemangioma was located in the perihepatic location)
II. Treatment history
Upon admission, the patient’s vital signs were disturbed, her heart rate was significantly accelerated, and her blood pressure dropped sharply. The patient’s boyfriend arrived at the hospital in time, and after a short and urgent communication with him, the family agreed to the operation and signed in time, and we also scrambled to improve the preoperative preparation and performed the dissection + partial right hepatectomy in time, which bought precious time for the patient. After the operation, the patient’s hemorrhage was controlled, and his vital signs gradually recovered and turned to safety.
III. Treatment effect
The bleeding of this patient was controlled after aggressive surgery because the bleeding did not reach a fatal level due to timely delivery to the hospital. Since the patient had more bleeding before surgery and was weaker, the postoperative recovery time was longer. The patient was discharged from the hospital after more than one month with a good overall recovery status and normal indicators. At the time of discharge, the patient was advised to review the liver function and hepatobiliary ultrasound every six months or so to observe the recovery of the liver under the condition of good recovery.
IV. Precautions
We are glad that the patient was successfully discharged from the hospital for recuperation after active treatment. However, as the patient was not completely cured at the time of discharge, he still needs to continue to recuperate after discharge and should not be taken lightly.
1, regular re-examination after discharge to monitor changes in indicators and recovery after laparotomy, whether there are intestinal adhesions, infections, fluid accumulation and other adverse factors.
2.After discharge, pay attention to monitoring changes in their digestive function, body temperature, heart rate, etc., and pay attention to whether abnormal abdominal pain, bloating, diarrhea, bloody stools and other symptoms occur in daily life.
3.The recuperation time after discharge is usually 2-3 months, during the recuperation period, you should not stay in bed all day, you need to do appropriate activities every day, but the intensity of exercise should be adjusted at any time according to your recovery. Remember not to carry out moderate or strong physical activities in the early recuperation period to prevent secondary injuries.
4.After discharge from the hospital, avoid excessive high-fat and high-cholesterol diet, smoking and alcohol.
V. Personal insight
In the face of critical patients, medical personnel are often required to have excellent professional skills, good multidisciplinary cooperation and self-dedication in order to save more patients in emergency situations. Although hepatic hemangiomas are benign tumors in clinical practice, they may increase in size if they are subjected to long-term external stimuli, such as long-term hormonal stimulation and long-term negative emotional influences. Therefore, if liver hemangioma is found during physical examination or surgery, care should be taken to avoid oral estrogenic drugs; in daily life, attention should be paid to protecting the upper abdomen from violence such as trauma, car accidents, and fights, which may lead to rupture of liver hemangioma; regular medical checkups should be conducted according to medical prescriptions, and the time limit of medical checkups should not exceed one year as much as possible, and should be reduced if necessary, in order to get better attention to one’s disease.