Acute abdomen as form of presentation of hepatic adenoma

The case is described of a 33-year-old woman with an 8-year history of oral contraceptive (OC) use who was treated at a hospital in Buenos Aires for a hepatic adenoma. The woman was admitted with an acute abdomen. Apart from OC use she had a history of hypertension for which she was treated with clonidine and diuretics. The physical findings included pain in the right abdomen involuntary guarding vomiting and fever. Ultrasonography showed a normal bladder and pancreas and a nodular image in the right hepatic lobe. A CAT scan revealed a mass in the right hepatic lobe and a needle biopsy later showed normal hepatic cells. Laparoscopy revealed a solid formation from which blood was obtained on puncturing. Angiography showed tortuous hepatic arteries. Laboratory tests were normal. An exploratory laparotomy was performed when the different studies failed to establish a clear diagnosis. A tumor was found in the right hepatic lobe but was not respected because the frozen section biopsy did not show malignant cells. The definite diagnosis of hepatic adenoma was based on the definitive biopsy. OC treatment was terminated and the tumor was in almost complete remission 1 year later. Hepatic adenomas are benign tumors usually single which occur rarely and primarily in women aged 30-40 who use OCs. A review of the literature indicated that the forms of presentation of hepatic adenoma are very varied. Pain was the initial symptom in 12-52% of cases. The pain was of sudden onset in 1/3. Hepatic adenoma is however infrequently considered as a cause of acute abdomen. Treatment in 73% of cases is surgical because of the danger of hemorrhage and shock and because of the potential for malignant transformation.