Giant hepatic haemangioma rupture in a patient on direct oral anticoagulant therapy

Marie Nguyen; Aaron E Lim; Eshwarshanker Jeyarajan; Mary-Ann Koh; Andrew Ng; Phillip Townend

doi:10.1093/jscr/rjaa523

Giant hepatic haemangioma rupture in a patient on direct oral anticoagulant therapy

J Surg Case Rep. 2021 Jan 29;2021(1):rjaa523. doi: 10.1093/jscr/rjaa523. eCollection 2021 Jan.

Authors

Marie Nguyen¹, Aaron E Lim¹, Eshwarshanker Jeyarajan¹, Mary-Ann Koh², Andrew Ng³, Phillip Townend¹

Affiliations

¹ Department of General Surgery, Gold Coast University Hospital, Gold Coast, Australia.
² Department of Anatomical Pathology, Pathology Queensland, Gold Coast University Hospital, Gold Coast, Australia.
³ Department of Radiology, Gold Coast University Hospital, Gold Coast, Australia.

Abstract

Rupture of a liver haemangioma is extremely rare, with less than 100 cases reported in the literature. This is the first case known to date reporting a rupture occurring with direct oral anticoagulant therapy. A 76-year-old woman presented with acute abdominal pain and syncope in the context of commencing apixaban 4 weeks prior. Abdominal computed tomography and angiography demonstrated a large heterogenous mass in the left liver lobe with contrast blush suggestive of a bleeding tumour. Urgent transcatheter arterial embolization successfully ceased haemorrhage. Due to persistent compressive symptoms, a left lateral hepatectomy was performed. CD34 immunostaining of the tissue revealed variably sized vessels, which was consistent with a ruptured giant hepatic haemangioma. Our case substantiates the limited available literature regarding ruptured haemangiomas. Combined with previous case reports, this report will significantly contribute to our understanding of the risk factors, diagnosis and surgical indications for ruptured hepatic haemangiomas.

Keywords: anticoagulation; embolization; liver haemangioma; open surgery; rupture.

Publication types

Case Reports