A Case Report of Liver Adenomatosis Complicated by Intraperitoneal Rupture and Hemoperitoneum Treated with an Emergent Left Lateral Segmentectomy

Hiroshi Nakano^{1) 2)}, Daniel Jaeck²⁾, Marie-Pierre Chenard-Neu³⁾, Hitonobu Moriya¹⁾, Takuya Yamamura¹⁾ and Susumu Yamaguchi¹⁾

Department of Gastrointestinal Surgery, St Marianna University School of Medicine¹⁾
Centre de Chirurgie Viscérale et de Transplantation²⁾
Service d' Anatomie Pathologique, Hôpital de Hautepierre, Université Louis Pasteur³⁾

Liver adenomatosis (LA) is a rare disease defined by the presence of multiple hepatic adenomas. Notable complications of LA requiring a surgical resection are intraperitoneal rupture and malignant transformation. However, among several reports of LA, few studies have summarized cases with LA complicated by intraperitoneal rupture. The present case-report showed a patient with LA who underwent an emergency hepatectomy due to spontaneous intraperitoneal rupture, and summarized reported cases of LA with intraperitoneal rupture. A 41-year-old French white female presented with a sudden onset of severe epigastralgia, unconsciousness, and hemodynamic shock. She had been taking an oral contraceptive for the last 5 years. Abdominal images showed intraperitoneal fluid collection, multiple bilobar hepatic nodules, and another ruptured hepatic tumor in the left lateral lobe. An emergency surgery was performed and the diagnosis of LA was proved. The ruptured tumor was resected by a left lateral segmentectomy with an intent of hemostasis, and the patient was cured. A pathological examination confirmed multiple adenomas of the liver. Ten LA cases with intraperitoneal rupture and hemoperitoneum have been reported including the present case. Characteristics of these patients were young generation, slight female preponderance, relation of oral contraceptive use, a risk of rupture in case of a more than 5 cm nodule of LA, and a risk of rupture of a left lobe nodule.

Key words
liver adenomatosis, intraperitoneal rupture, hepatectomy

Reprint requests
Hiroshi Nakano Department of Gastroenterological Surgery, St. Marianna University School of Medicine 2-16-1 Sugao, Miyamae-Ku, Kawasaki, 216-8511 JAPAN

Accepted
March 26, 2003

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