Mikami T, Hirata K, Oikawa I, Kimura M, Kimura H
First Department of Surgery, Sapporo Medical University School of Medicine, Japan.
Surg Today. 1998;28(9):948-52. doi: 10.1007/s005950050259.
We report herein the extremely unusual case of a 39-year-old woman in whom a giant cavernous hemangioma caused hemobilia. Cavernous hemangioma is the most common benign neoplasm of the liver and rarely causes any clinical symptoms or signs, while hemobilia usually occurs secondary to accidental operative or iatrogenic trauma, vascular disease, inflammatory disorders, gallstones, or tumors of the liver. Although invasive or malignant hepatic tumors often result in a communication between the biliary tract and the blood vessels, only one case of hemobilia caused by a benign cavernous hemangioma has ever been reported, but with no details about the patient. Our patient presented to a local hospital with severe melena as the initial main symptom, where ligation of the right hepatic artery was performed. This failed to relieve her symptoms, and she was subsequently referred to our department where a right hepatectomy was performed. Histopathological examination revealed no malignancy combined with the tumor; however, the hemangioma was exposed to the bile duct in segment VIII, which was presumably the cause of the hemobilia. This patient remains in good health almost 6 years after her operation. To the best of our knowledge this is the first case report of hemobilia caused by a cavernous hemangioma, and is accompanied by a detailed analysis.
我们在此报告一例极为罕见的病例，一名39岁女性因巨大海绵状血管瘤导致胆道出血。海绵状血管瘤是肝脏最常见的良性肿瘤，很少引起任何临床症状或体征，而胆道出血通常继发于意外手术或医源性创伤、血管疾病、炎症性疾病、胆结石或肝脏肿瘤。尽管侵袭性或恶性肝肿瘤常导致胆道与血管之间的交通，但仅有一例由良性海绵状血管瘤引起的胆道出血报道，但未提及患者的详细情况。我们的患者最初以严重黑便为主诉就诊于当地医院，在那里进行了右肝动脉结扎术。这未能缓解她的症状，随后她被转诊至我们科室，在那里进行了右肝切除术。组织病理学检查显示肿瘤无恶性成分；然而，血管瘤在Ⅷ段暴露于胆管，这可能是胆道出血的原因。该患者术后近6年仍健康状况良好。据我们所知，这是首例由海绵状血管瘤引起的胆道出血病例报告，并伴有详细分析。
