The Treatment of Liver Hemangioma Associated with Kasabach-Merritt Syndrome in Neonates

ABSTRACT

Hemangioma is the most frequent liver tumor in infancy. The treatment of hepatic hemangioma includes medical, surgical, and non-operative interventional therapy. There are no standard medical regimens currently considered consistently effective. MDMP (megadose methylprednisolone) and alpha-interferon can be used for medical treatment. Interventional occlusion of feeding arteries in symptomatic hepatic hemangioma is considered a safe and effective alternative to early open surgery. Untreated symptomatic patients with heart failure have a high mortality rate. For this reason symptomatic patients with heart failure may require non-operative treatment such as interventional embolization, because hepatic resection is burdened with high risk. We report our experiences of two patients with neonatal liver hemangiomas whose clinical courses were complicated by cardiac failure to whom medical treatment and/or interventional vascular occlusion were done. Both patients had Kasabach-Merritt syndrome complicated with cardiac failure. Initially, the masses were considered unresectable. In one case, we performed interventional therapy in addition to medical treatment. In another case, we tried medical therapy with megadose steroid and alpha-interferon. Unfortunately, in spite of the treatments, the patients died of severe hemorrhage.