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

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.