ABSTRACT
Six cases of ruptured hepatic adenoma treated in our medical center were reviewed with attention directed toward presenting symptomatology and methods of treatment. These patients, five women who were long-term users of oral contraceptives and one man who had never taken steroid medication, presented with right upper quadrant abdominal pain of variable degree and duration. The cardiovascular status of these patients was also variable, ranging from a normal blood pressure, which allowed an orderly workup, and planned resection of the tumor to hypovolemic shock requiring emergency laparotomy for control of hemorrhage. The extent of surgery depended on the location and the number of adenomas, with the goal being to resect the adenoma and control hemorrhage while preserving as much normal liver parenchyma as possible. The treatment of choice in this disease is resection of the tumor with a margin of normal liver parenchyma. In those cases in which that is not practical, resectional debridement has proven to be an effective alternative.
Subject(s)
Carcinoma, Hepatocellular , Contraceptives, Oral/adverse effects , Liver Neoplasms , Adult , Carcinoma, Hepatocellular/chemically induced , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/surgery , Female , Hematoma/etiology , Humans , Liver Neoplasms/chemically induced , Liver Neoplasms/complications , Liver Neoplasms/surgery , Male , Rupture, Spontaneous , Time Factors , Tomography, X-Ray ComputedABSTRACT
Four patients with intraluminal diverticulum of the duodenum are presented and compared with those reported previously. This lesion is a rare congenital disorder that usually becomes symptomatic in adult life. It is located in the second portion of the duodenum within the lumen, extending distally. It has the appearance of a "thumb of a glove" and it is lined by mucosa on both surfaces. It develops betweeen the fourth and eighth week of the embryo's life, but it increases in size during adult life. It usually presents with typical or atypical symptoms of peptic ulcer disease, but sometimes manifestations such as gastrointestinal bleeding, duodenal obstructions or pancreatitis may predominate and may be severe and life-threatening. The diagnosis is best made with hypotonic duodenography, which demonstrates the lesion as a barium coated pouch within the air filled duodenal lumen. The treatment of choice is duodenotomy and excision of the lesion. Proper identification of the papilla of the ampulla of Vater is important since this structure is often adjacent to the diverticulum. No recurrences have been noted in the three patients operated upon.
