Giant hepatic hemangioma with Kasabach-Merritt syndrome: is the appropriate treatment enucleation or liver transplantation?

We present a case of giant cavernous hemangioma of the liver with disseminated intravascular coagulopathy (Kasabach-Merritt syndrome) which was cured by enucleation. The 51 year old woman presented with increased abdominal girth and easy bruisability. Workup elsewhere revealed a massive hepatic hemangioma and she was started on radiation therapy to the lesion and offered an orthotopic liver transplant. After careful preoperative preparation, we felt that resection was possible and she underwent a successful enucleation. The operation and postoperative course were complicated by bleeding but she recovered and remains well in followup after 6 months. All coagulation parameters have returned to normal. Enucleation should be considered the treatment of choice for hepatic hemangiomas, including those presenting with Kasabach-Merritt syndrome. The benefits of enucleation as compared to liver transplantation for these lesions are discussed.