Treatment of ruptured hepatocellular adenoma

Background: As the morbidity and mortality rates associated with emergency resection in patients with a ruptured hepatocellular adenoma are high, the authors have favoured initial non-operative management in haemodynamically stable patients. Methods: A retrospective study was performed to evaluate the treatment of r uptured hepatocellular adenoma. Results: Over a 21-year interval, 12 patients presented with a ruptured hep atocellular adenoma. Haemodynamic observation and support was the initial m anagement in all 12 patients. Three underwent urgent laparotomy and gauze p acking because of haemodynamic instability; no emergency liver resection wa s necessary. Eight patients had definitive surgery; three developed postope rative complications but none died. Regression of the tumour was observed i n three of four patients treated conservatively. Conclusion: The initial management of a ruptured hepatocellular adenoma sho uld be haemodynamic stabilization. Definitive resection is required for reb leeding or for tumours exceeding 5 cm in diameter. A conservative approach may well be justified in case of regression of an asymptomatic adenoma.