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    Liver Haemangioma Resection

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    drhiwaomer
    Sadia Ahmed 23 years old female from Chamchamal / Suleimania / Kurdistan Government Iraq. Presented with hematemesis and malena to Shorish military hospital. Recurrent in nature, moderate in amount. Receiving over all 12 pints of blood in a course of one month. Many times scoped in Baghdad and undiagnosed. US revealed 5 cm echogenic lesion, round shape in the right lobe of the liver, deeply seated. At the time of admission she was shocked, rapid circulatory support has performed by blood transfusion and then scoped which revealed hemobilia. The procedure took 35 min. PCV 22% WBC 8000/ml ESR 60mm/hr. GUE inconclusive BU 55 mg/dl Serum amylase not available. Electrolyte, cid base and blood gas not available. Coagulation profile was not available apart from bleeding and clotting time both of which were normal. Liver function shows mild increase in TSB 3mg/dl and mildly raised Alkaline phosphatase 17 KAU Angiography was not available. And the CT has not been done because of the unstability of the patient's condition. Blood group A+ Chest XR and ECG were normal . No other investigation were available in that small hospital in hard days of Saddam's Erra. Exploration was urgent and done by Kokher incision the bile duct has been seen dilated with greenish color. It has been explored and the blood was evacuated . Pringles maneuvers has been applied and follys catheter ball has been used to localize the site of the bleeding as the first case and the lesion has been located in the upper biliary tree. Segmental resection of the segment 6 of the liver was done depending on palpation of the firm lesion. The biliary tree has been cleaned and the duct has been closed on T- tube. She had uneventful recovery. Discharged 10 days later. After 3 weeks of the initial surgery she had the same presentation of upper GIT bleeding, the scope again revealed hemobilia. She has been explored again after resuscitation and the firmness was extending to the wider area of the right lobe involving segment 5. The blood was coming from both ducts even after repeated wash out. Longitudinal gauze pack has been inserted repeatedly to both ducts, the result was not very conclusive because both biliary tree were full of blood and it was difficult to clear them completely. It made us in a mess. We has been obliged to do right hepatic lobectomy by thoraco-abdominal incision due to difficulties in the area made by the previous surgery. There was no way to locate the source except by palpation. Which revealed indurations in the right lobe with almost normal consistency of the left lobe. On this base of the operative decision was right hepatic lobectomy. Fortunately she had uneventful recovery and the histopathology was consitent mostly with amoebic liver abscesse. Date of Admission 5/9/2001 Date of Discharge 15/9/2001.

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    Liver Haemangioma Resection

    Uploaded by

    drhiwaomer
    239 views38 pages
    Sadia Ahmed 23 years old female from Chamchamal / Suleimania / Kurdistan Government Iraq. Presented with hematemesis and malena to Shorish military hospital. Recurrent in nature, moderate in amount. Receiving over all 12 pints of blood in a course of one month. Many times scoped in Baghdad and undiagnosed. US revealed 5 cm echogenic lesion, round shape in the right lobe of the liver, deeply seated. At the time of admission she was shocked, rapid circulatory support has performed by blood transfusion and then scoped which revealed hemobilia. The procedure took 35 min. PCV 22% WBC 8000/ml ESR 60mm/hr. GUE inconclusive BU 55 mg/dl Serum amylase not available. Electrolyte, cid base and blood gas not available. Coagulation profile was not available apart from bleeding and clotting time both of which were normal. Liver function shows mild increase in TSB 3mg/dl and mildly raised Alkaline phosphatase 17 KAU Angiography was not available. And the CT has not been done because of the unstability of the patient's condition. Blood group A+ Chest XR and ECG were normal . No other investigation were available in that small hospital in hard days of Saddam's Erra. Exploration was urgent and done by Kokher incision the bile duct has been seen dilated with greenish color. It has been explored and the blood was evacuated . Pringles maneuvers has been applied and follys catheter ball has been used to localize the site of the bleeding as the first case and the lesion has been located in the upper biliary tree. Segmental resection of the segment 6 of the liver was done depending on palpation of the firm lesion. The biliary tree has been cleaned and the duct has been closed on T- tube. She had uneventful recovery. Discharged 10 days later. After 3 weeks of the initial surgery she had the same presentation of upper GIT bleeding, the scope again revealed hemobilia. She has been explored again after resuscitation and the firmness was extending to the wider area of the right lobe involving segment 5. The blood was coming from both ducts even after repeated wash out. Longitudinal gauze pack has been inserted repeatedly to both ducts, the result was not very conclusive because both biliary tree were full of blood and it was difficult to clear them completely. It made us in a mess. We has been obliged to do right hepatic lobectomy by thoraco-abdominal incision due to difficulties in the area made by the previous surgery. There was no way to locate the source except by palpation. Which revealed indurations in the right lobe with almost normal consistency of the left lobe. On this base of the operative decision was right hepatic lobectomy. Fortunately she had uneventful recovery and the histopathology was consitent mostly with amoebic liver abscesse. Date of Admission 5/9/2001 Date of Discharge 15/9/2001.

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    Sadia Ahmed 23 years old female from Chamchamal / Suleimania / Kurdistan Government Iraq. Presented with hematemesis and malena to Shorish military hospital. Recurrent in nature, moderate in amount. Receiving over all 12 pints of blood in a course of one month. Many times scoped in Baghdad and undiagnosed. US revealed 5 cm echogenic lesion, round shape in the right lobe of the liver, deeply seated. At the time of admission she was shocked, rapid circulatory support has performed by blood transfusion and then scoped which revealed hemobilia. The procedure took 35 min. PCV 22% WBC 8000/ml ESR 60mm/hr. GUE inconclusive BU 55 mg/dl Serum amylase not available. Electrolyte, cid base and blood gas not available. Coagulation profile was not available apart from bleeding and clotting time both of which were normal. Liver function shows mild increase in TSB 3mg/dl and mildly raised Alkaline phosphatase 17 KAU Angiography was not available. And the CT has not been done because of the unstability of the patient's condition. Blood group A+ Chest XR and ECG were normal . No other investigation were available in that small hospital in hard days of Saddam's Erra. Exploration was urgent and done by Kokher incision the bile duct has been seen dilated with greenish color. It has been explored and the blood was evacuated . Pringles maneuvers has been applied and follys catheter ball has been used to localize the site of the bleeding as the first case and the lesion has been located in the upper biliary tree. Segmental resection of the segment 6 of the liver was done depending on palpation of the firm lesion. The biliary tree has been cleaned and the duct has been closed on T- tube. She had uneventful recovery. Discharged 10 days later. After 3 weeks of the initial surgery she had the same presentation of upper GIT bleeding, the scope again revealed hemobilia. She has been explored again after resuscitation and the firmness was extending to the wider area of the right lobe involving segment 5. The blood was coming from both ducts even after repeated wash out. Longitudinal gauze pack has been inserted repeatedly to both ducts, the result was not very conclusive because both biliary tree were full of blood and it was difficult to clear them completely. It made us in a mess. We has been obliged to do right hepatic lobectomy by thoraco-abdominal incision due to difficulties in the area made by the previous surgery. There was no way to locate the source except by palpation. Which revealed indurations in the right lobe with almost normal consistency of the left lobe. On this base of the operative decision was right hepatic lobectomy. Fortunately she had uneventful recovery and the histopathology was consitent mostly with amoebic liver abscesse. Date of Admission 5/9/2001 Date of Discharge 15/9/2001.

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    239 views38 pages

    Liver Haemangioma Resection

    Uploaded by

    drhiwaomer
    Sadia Ahmed 23 years old female from Chamchamal / Suleimania / Kurdistan Government Iraq. Presented with hematemesis and malena to Shorish military hospital. Recurrent in nature, moderate in amount. Receiving over all 12 pints of blood in a course of one month. Many times scoped in Baghdad and undiagnosed. US revealed 5 cm echogenic lesion, round shape in the right lobe of the liver, deeply seated. At the time of admission she was shocked, rapid circulatory support has performed by blood transfusion and then scoped which revealed hemobilia. The procedure took 35 min. PCV 22% WBC 8000/ml ESR 60mm/hr. GUE inconclusive BU 55 mg/dl Serum amylase not available. Electrolyte, cid base and blood gas not available. Coagulation profile was not available apart from bleeding and clotting time both of which were normal. Liver function shows mild increase in TSB 3mg/dl and mildly raised Alkaline phosphatase 17 KAU Angiography was not available. And the CT has not been done because of the unstability of the patient's condition. Blood group A+ Chest XR and ECG were normal . No other investigation were available in that small hospital in hard days of Saddam's Erra. Exploration was urgent and done by Kokher incision the bile duct has been seen dilated with greenish color. It has been explored and the blood was evacuated . Pringles maneuvers has been applied and follys catheter ball has been used to localize the site of the bleeding as the first case and the lesion has been located in the upper biliary tree. Segmental resection of the segment 6 of the liver was done depending on palpation of the firm lesion. The biliary tree has been cleaned and the duct has been closed on T- tube. She had uneventful recovery. Discharged 10 days later. After 3 weeks of the initial surgery she had the same presentation of upper GIT bleeding, the scope again revealed hemobilia. She has been explored again after resuscitation and the firmness was extending to the wider area of the right lobe involving segment 5. The blood was coming from both ducts even after repeated wash out. Longitudinal gauze pack has been inserted repeatedly to both ducts, the result was not very conclusive because both biliary tree were full of blood and it was difficult to clear them completely. It made us in a mess. We has been obliged to do right hepatic lobectomy by thoraco-abdominal incision due to difficulties in the area made by the previous surgery. There was no way to locate the source except by palpation. Which revealed indurations in the right lobe with almost normal consistency of the left lobe. On this base of the operative decision was right hepatic lobectomy. Fortunately she had uneventful recovery and the histopathology was consitent mostly with amoebic liver abscesse. Date of Admission 5/9/2001 Date of Discharge 15/9/2001.

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    Provisional diagnoses –

    huge haemangioma of the liver in


    an infant

    Dr. Qalander Kasnazani


    Consultant surgeon

    Areen Star, Eight month old female, date: 17/5/2006,


    Shorish hospital. Kurdistan. Sulaimani
    Areen star, eight month old female. Presented with huge abdominal
    distention and refused to take milk properly. Blood count and blood film
    and biochemical study was raising the diagnose of iron deficiency
    anaemia and imagine revealed huge haemangioma of the liver.
    Exploration has been done after correction of very low hemoglobine and
    extensive liver reception has been done for entire left lobe of the liver by
    roof top incision. She had un-eventful recovery the histopathology was
    in favour of haemangiosarcoma. There was no extra hepatic
    involvement or any invasion or metastatic lymph nodes in the resected
    specimen. She did well after surgery and follow up is continuing with her.
    30 years old female ,presented with upper abdominal pain, sever and
    constant,interferes with life style of the patient ,the main findings was a big upper
    abdominal mass which was tender and firm .moves with respirations she was pale and
    had pain on her expression during the exam. Previosly operated for livar mass which
    has been left without interferance.and the abdomen was immediately closed.
    Upper abdominal ultra has revealed big haemangioma of the liver which has been
    proved by M R I .SHE HAD HER Hb of 9 gm per del.
    Her liver function was all normal.and so all other investigations.
    The mass was involving most of her right lobe keepin the left lobe free of any
    involvement. Right hemi hepatectomy has been performed for her and she had un
    eventful recovery .
    The slides has been provided as follows:

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