Spontaneous Rupture of a Large Exogastric Hemangioma Complicated by Hemoperitoneum and Sepsis

Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Journal of the Formosan Medical Association (Impact Factor: 1.97). 01/2007; 105(12):1027-30. DOI: 10.1016/S0929-6646(09)60289-8
Source: PubMed


Hemangiomas are benign congenital tumors of mature blood vessels and usually consist of dense masses of capillaries or larger blood vessels. Hemangioma of the stomach presenting with spontaneous rupture and sepsis is rare. We report a 22-year-old male who presented at the emergency room with sudden-onset epigastric pain, intractable nausea, and vomiting. Fever, tachycardia, leukocytosis and peritonitis were found on examination after admission. Computed tomography revealed a single, well-defined homogeneous lesion measuring approximately 6 x 8 x 9 cm in size over the left upper abdomen and hemoperitoneum. Laparotomy was performed because of intra-abdominal hemorrhage, peritonitis, and fever. During the operation, a dark red tumor was found on the greater curvature side of the stomach, accompanied by bleeding and hemoperitoneum. The tumor was removed and a wedge resection of the stomach and partial omentectomy were performed. Histopathologic examination of the excised tumor revealed mixed cavernous-capillary hemangioma with central necrosis. The postoperative course was uncomplicated. The pathogenesis of spontaneous rupture and sepsis in this case may have resulted from pedicle torsion accompanied by ischemia, central necrosis, rupture of hemangioma and subsequent peritonitis and sepsis.

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    • "Ruptured cholangiocarcinomas can rarely present with spontaneous hemorrhage [12]. A mixed cavernous-capillary hemangioma with central necrosis can occur on the greater curvature of the stomach, accompanied by bleeding and hemoperitoneum [13]. Other rare conditions associated with hemoperitoneum include transhepatic rupture of the gall bladder, which has been described fewer than 20 times in the literature [14]. "
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