Liver Hemangioma Bleeding Rupture Misdiagnosed as Acute Appendicitis

LIU Zhuang

doi:10.3969/j.issn.1002-3429.2014.12.012

Abstract：Objective To explore the clinical characteristics of liver hemangioma rupture bleeding, and evaluate its differ-ential diagnosis. Methods Retrospectively analysis of the clinical data of a case of multiple liver hemangioma rupture hemorrhage misdiagnosed as acute appendicitis was made. Results A patient with lower abdominal pain for 20 hours before admission was pri-marily diagnosed as having acute appendicitis, and underwent an emergency laparotomy. During the operation, no abnormal appen-dix was found, but a mass in liver with burst bleeding was found and the liver surface was full of millet qualitative hard nodules. Be-cause of impossible determination on the nature of the tumor, the patient was given local hemostasis therapy, and abdominal cavity was washed, then drainage tube was placed at the same time, some tissues surrounding bleeding mass was removed, and no active bleeding before abdominal closing was observed. Postoperative pathologic result of liver mass showed degeneration of liver cells, with cellulose and inflammatory cells, and reinforced CT scanning confirmed liver hemangioma rupture bleeding, but to define the cause of bleeding, a followed enquiry of history and related examinations were made before systemic lupus erythematosus (active phase) was confirmed. Gamma globulin and Methylprednisolone treatment were given and the patient was discharged after improvement. Conclusion Because of the particular position, patients with liver hemangioma (right liver lobe) rupture hemorrhage usually have atypical clinical symptoms and signs, which may be related to systemic lupus erythematosus and mistaken as acute appendicitis.