SURGİCAL TREATMENT OF THE TROMBOSED LİVER HEMANGİOMA COMPLİCATED WITH OBSTRUCTIVE JAUNDICE

N.Y. BAYRAMOV, A.S. GADIROVA, N.H. NOVRUZOV, A.K. SAFIYEVA

Central customs hospital, Baku, AZERBAIJAN

Background/aims:Hemangioma is one of the most common (35-40%) benign, mesenchymal, vascular tumors of the liver, is a congestive vascular malformation with the occurrence in 7% of population. The clinical presentation depends on the size, location, growth rate, the degree of destruction, compression of the surrounding liver parenchyma and the presence of complications.

There are cavernous, capillary (simple) and membranous, and in some sources sclerotic forms. For diagnostic purposes physical examination (hepatomegaly, palpable tumor, systolic noise); laboratory examination (thrombocytopenia with Kazabaha-Merritt syndrome), US (sensitivity 61%), percutaneous biopsy; CT (77 %), MR imaging (92%), selective hepatic angiography (93%), radionuclide scintigraphy with erythrocytes labeled with Tc99m; positron emission tomography (PET) and laparoscopy are used. Among the treatment methods ligation and embolization of hepatic artery, radiotherapy, corticosteroids, liver resection and enucleation of tumors are applied. There is research on the regressive effect of recombinant α-2-interferon and on inhibitors of vascular endothelial growth factor (bevacizumab) on the cavernous hemangioma of the liver. In recent years, 30 cases of hemangioma rupture with internal bleeding were described, while intratumoral bleeding occurs much more frequently. Rare complications are the Kazabaha-Merritt syndrome and thrombosis with subsequent inflammation of the cavernous hemangioma.

Methods: During the period 2002-2009 we observed 4 patients with inflammation of the thrombosed giant hemangioma of the liver with the development of obstructive jaundice. Abscess replaced the entire right portion of the liver with involvement in the process of the gallbladder. The right lobe of the liver was subjected to the total necrosis, the left lobe increased in size. Of the 4 patients with cavernous hemangioma of the liver, three of came with an obstructive jaundice, one with a liver abscess. After drainage of the abscess in the postoperative period, a biliary fistula has formed, which spontaneously closed within the next 3 years. The remaining patients with obstructive jaundice in 2 cases in the first step bilodigestive anastomosis was conducted and resulted in the development of the anastomosis stricture. Furthermore it was followed by a planned extensive liver resection. Only one patient received a one-stage extensive liver resection. Cavernous hemangioma of the liver with a thrombosed vascular lacunae, pronounced leukocytic infiltration, necrosis of liver tissue. In the postoperative period 3 patients had biliary fistula formed, which spontaneously closed in the case of one patient, while two of them had ERCPQ+ST, which had a positive result with one patient.

Conclusion: Thrombosis of the very fabric of hemangiomas and necrosis of the gall bladder and biliary tracts is conducive to the inflammation of hemangioma. Thus, in patients with a complicated cavernous hemangioma of the liver a radical approach in the form of one-stage liver resection is recommended.

Date: 2014-12-28; view: 1182