Right hepatectomy with anterior approach for ruptured liver cell adenoma.

We report a case of a 37-year-old woman who was referred to a peripheral hospital with severe abdominal pain, vomiting and hemorrhagic shock. Ultrasonography and CT scan showed a large ruptured adenoma of the right liver. Because of hemodynamic instability, she underwent laparotomy with gauze packing and then she was referred to our department with a bleeding persisting at a rate of about 100 mL per hour from the abdominal drain. She underwent relaparotomy and a ruptured liver cell adenoma with a huge hepatic hematoma completely involving the right liver and part of segment 4 was confirmed. Considering the size of the lesion and the presence of a large hematoma, a right hepatectomy with anterior approach was performed. In case of emergency liver resections, the anterior approach is preferable not only to avoid tumor manipulation and the risk of its rupture, but mainly to reduce liver bleeding and to prevent sudden fall of the blood pressure due to inferior vena cava twisting in a hemodynamically instable patient. Intraoperative blood loss was 1500 mL. The postoperative course was uneventful. The patient is doing well ten months after operation.