Laparoscopic Management of Large Left Lobe Hepatic Hemangioma Presenting as Gastric Hemangioma on Radiology: A Case Report and Literature Review

Hepatic cavernous hemangiomas are the most common benign tumors of the liver. They can be found incidentally in the general population in up to 20% of the cases. On the other hand, gastric hemangioma is a very rare entity. These tumors account for only 0.05% of all gastrointestinal (GI) neoplasms. Hemangiomas have no malignant transformation potential. They are detected using CT-scan or MRI. Endoscopy can play a role in the differentiation of gastric from hepatic hemangiomas. Hepatic hemangioma can be associated with portal vein thrombosis as a mass effect resultant. Surgery is recommended for the treatment of symptomatic hemangiomas or giant ones (above 10cm). Laparoscopy is recommended for symptomatic hemangiomas less than 4cm or those who harbor a vascular pedicle. Here we present a case of a 50-year-old male presenting with a history of 1 month duration of epigastric pain and 5 kilograms of weight loss diagnosed on imaging studies with gastric hemangioma and partial portal vein thrombosis. Laparoscopic approach was adopted to deal with his condition. Intra-operatively, he was found to have hepatic hemangioma of around 10cm associated with complete atrophy of the left liver lobe. Decision was taken intra-operatively to carry a laparoscopic left hepatectomy regardless of all the challenges that pose laparoscopy in general for any hepatectomy. This decision was taken due to the presence of a vascular pedicle, which was clipped for hemostatic control.