Hepatocellular adenomas with severe intra-abdominal bleeding, related to an underlying coagulation disorder: a case report

• Published in: Journal of medical case reports Vol. 18; no. 1; pp. 367 - 6
• Main Authors: Oudmaijer, C A J, Sprakel, J, Sprengers, D, Wiese, K A, Tintel, N Vogelaar, Franken, J I, Terkivatan, T, Porte, R J, IJzermans, J N M
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.08.2024; BioMed Central; BMC
• Subjects: Adenoma, Liver Cell - complications; Adenoma, Liver Cell - therapy; Adult; Body mass index; Case Report; Embolization, Therapeutic; Estrogen; Female; Health aspects; Hepatocellular adenoma; Humans; Intra-abdominal bleed; Liver; Liver Neoplasms - complications; Oral contraceptives; Pulmonary embolism; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - etiology; Rivaroxaban; Treatment strategy; Treatment strategy; Case report; Hepatocellular adenoma; Intra-abdominal bleed
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-024-04709-7

Hepatocellular adenoma is a rare benign liver tumor. Typically, hepatocellular adenomas are solitary and are found in young women who use estrogen-containing contraceptives. The occurrence of multiple hepatocellular adenoma has been linked to higher body mass index, and as the prevalence of overweight increases, multiple hepatocellular adenomas are seen more often. An hepatocellular adenoma does not always necessitate treatment, as they can regress under conservative strategies. In incidental cases, an adenoma presents owing to bleeding, which is mostly self-limiting. If it is not, embolization of hepatic involved vessels is indicated. In this case report, we discuss a 42-year old Caucasian woman with multiple hepatocellular bleeds, treated by multiple endovascular procedures. After the first embolization of an adenoma in the right liver lobe, a second bleed occurred in the left lobe, necessitating additional endovascular intervention. During admittance, treatment was complicated by pulmonary embolism and a pneumonia. During follow-up, our patient was diagnosed with antiphospholipid syndrome. Hepatocellular adenoma is a rare diagnosis that requires centralized expertise. This particular case illustrates the complexity of treatment strategies for associated intra-abdominal bleeding and possible complications. Although liver adenoma is often an incidental finding, it can also result in significant morbidity. Centralization of treatment leads to expertise in managing complex treatment strategies.