[Treatment of 8 patients with an acute hemorrhage in a hepatocellular adenoma at the Academic Medical Center, Amsterdam].

Objective: Evaluation of the early management and treatment of patients with an acute haemorrhage in a hepatocellular adenoma.
Design: Descriptive.
Setting: Academic Medical Centre (AMC), Amsterdam, the Netherlands.
Method: In the period 1989-1996, eight women with an acute haemorrhage in a hepatocellular adenoma were treated in the AMC. Four had an intrahepatic bleeding which initially was treated conservatively. The other four patients arrived with a haemoperitoneum for which laparotomy was immediately performed: in three, the haemorrhage was stopped by gauze tamponade and in one, the tumour was removed by bisegmental resection. In all seven initially not subjected to resection, the tumour was removed later by partial hepatectomy.
Results: The condition stabilized in all patients after initial conservative treatment or after laparotomy and gauze tamponade. The tamponade gauzes were removed after 48 hours. The definite treatment, after 2-4 months, consisted of right-sided hemihepatectomy (four patients), left-sided hemihepatectomy and (bi)segmental resection (three). Three patients showed postoperative complications: infected haematoma, bile leakage and a non-infected subphrenic haematoma. In half the patients, the pathological diagnosis was not certain owing to the effects of the recent bleeding. In one patient, a highly differentiated hepatocellular carcinoma could not be excluded.
Conclusion: Patients with a haemorrhage in a hepatocellular adenoma without signs of rupture should be treated conservatively. An effective and safe first treatment of an unstable patient with haemoperitoneum is laparotomy and staunching of the bleeding by gauze tamponade. This management is feasible in every general hospital, following which the patient may be referred to a specialized centre for further diagnosis and treatment. It is advisable to remove the tumour surgically after about three months.