Haemoperitoneum due to spontaneous rupture of hepatic haemangiomatosis: Treatment by superselective arterial embolization and partial hepatectomy

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Abstract
SUMMARY: A case is reported of a 36 year old woman with haemoperitoneum due to spontaneous rupture of hepatic haemangiomatosis. Computed tomography showed a subcapsular hepatic mass in the posterior segment of the right hemiliver (subsegment 7) containing a fluid‐fluid level. Magnetic resonance imaging depicted a subcapsular hepatic mass displaying an internal fluid‐fluid level suggestive of haematoma. Hepatic angiography showed an intense arterial blush in the area of the subsegment 7 and permitted a subsequent and temporarily effective superselective transcatheter embolization of the subsegmental arterial branch for subsegment 7. Because of a recurrence of intraperitoneal haemorrhage 15 days after the first embolization, a new selective hepatic artery embolization was performed. However, intraperitoneal haemorrhage recurred 10 days after the second embolization, and the patient underwent resection of the posterior segments of the right hemiliver (subsegments 6 and 7). This case suggests that superselective arterial embolization, when used alone, does not provide a permanent treatment of haemoperitoneum due to spontaneous rupture of hepatic haemangiomatosis. However, this technique seems to be useful in avoiding an emergency surgery, allowing a planned hepatic resection.