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Giant Hepatic Hemangioma Managed with Resection through a combination of median sternotomy and laparotomy , after attempted Angioembolisation and sorafenib therapy.- A Case report.

GNANASEKAR M MURUGAIYAN

Abstract


Abstract Giant Symptomatic Hepatic Hemangioma,
demanding surgical intervention
can pose problems owing to their
large size . Here we report a case of Giant
hepatic Hemangioma of size 37x19x
15 cm in a 34 year old female ,who remained
symptomatic for 6 months .Since
the hemangioma was actually growing
and she complained of increasing abdominal
and respiratory symptoms, we
decided to intervene. First we performed
transcatheter arterial embolization(TAE)
of the hepatic arteries,which failed to
cause regression of the size and her
symptoms. As a next measure, we
started sorafenib ,based on a similar
such case report in Japan.The tumor
shrunk with symptomatic improvement.
But unfortunately the drug could not be
continued because of the intolerable side
effects, which terminated in stoppage of
the drug..With her symptoms worsening ,
we planned for surgical resection.
Surgery was done along with Thoracic surgeons
,wherein we employed a median
sternotomy and Makucchi incision. Intrapericardial
IVC was accessed and kept
ready for possible venovenous bypass if
necessity arises. Inflow achieved with intermittent
pringles maneouvre. Complete resection
of the lesion was done.


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