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INTRODUCTION: Hepatic hemangioma is the most common benign tumor in the liver. Although intra-abdominal bleeding associated with its rupture is rare, but life-threatening. Here we report a case of ruptured hepatic hemangioma and applied method for controlling its bleeding. CASE REPORT: The patient was a 45-year-old man who was referred after crashing his motorcycle into a car. The patient's primary survey revealed intra-abdominal free fluid, but stable vital signs. Thirty minutes later, the patient's systolic blood pressure dropped to 85 mmHg. Laparotomy was performed a large hemangioma was observed involving almost the entire left lobe of the liver. Using a liver needle and 2-0 chromic suture, we entered the hemangioma at the perforation site of the lower portion of the liver and exit from the upper part. Then, we entered the upper part of the liver and exited from the lower part, and then it was tied. According to this approach, hemangioma was packed from the lower segment of the liver. CONCLUSION: In this case, the patient's abdomen was primarily closed without extra packing and embolization. The proposed method thus may be more effective compared to conventionally used methods.
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BACKGROUND: Health technology assessment (HTA) is a tool utilized for efficient dissemination of technology. For the purpose of encouraging decision-makers to utilize this tool, at first, we need to identify the obstacles in the processes of preparation, utilization, and implementation of HTAs. This study aims to define these barriers and offer solutions for effective utilization of HTA reports produced in Iran. METHODS: This qualitative content analysis determines the various beneficiaries of HTA, and utilizes a semi-structured interview with the participants who are all involved in the HTA. RESULTS: Nine out of ten people invited for the interviews accepted the researchers' invitation. An analysis of barriers and solutions for improving the utilization of HTA reports was conducted in three levels of policy makers (policy level), specialists in healthcare (professional level), and ordinary people (public level). The barriers in the policy level include unsuitability of reports for their audience, incompatible views toward the definition and necessity of health technology assessment, lack of financial resources for report preparation, and limitations in large-scale policymaking in Ministry of Health. Barriers in the professional level include lack of knowledge on HTA among serviceproviders. Barriers in the public level consist of information asymmetry. CONCLUSION: There are various barriers toward accurate utilization of HTAs in Iran. Thus, a systematic approach which involves people, brings about culture, improves infrastructures, and boosts supervision on the performance is recommended.
