Massive liver haemangioma causing Kasabach-Merritt syndrome in an adult.

Liver haemangiomas are common, but their size very rarely exceeds 40cm. Most people with liver haemangiomas are asymptomatic, and diagnosis is usually made incidentally during imaging for other complaints. When a liver haemangioma is symptomatic or produces complications, surgical intervention may be warranted. Kasabach-Merritt syndrome is an uncommon complication reported in certain rare vascular tumours in children, with only a few cases reported in adults. The syndrome describes a consumptive coagulopathy initiated within a vascular tumour, mainly tufted angiomas and kaposiform haemangioendotheliomas and, less commonly, giant haemangiomas. The process can extend beyond the tumour and become disseminated in certain cases due to trauma or surgery. The definitive treatment for giant liver haemangiomas can include arterial embolisation, surgical excision, hepatectomy or even liver transplantation. We report the case of a 32-year-old woman with a 42 × 32 × 27cm (18,870ml) liver haemangioma associated with Kasabach-Merritt syndrome. The diagnosis was challenging, even with proper imaging, owing to the rarity of the condition. It was achieved with an exploratory laparotomy with biopsy.

Small bowel obstruction due to splenosis 30 years after splenectomy.

Splenosis is the autotransplantation of splenic tissue into abnormal locations due to trauma or iatrogenically. Usually, this causes no symptoms, but in rare cases the mass effect of the transplanted nodules can cause small bowel obstruction. Resection of the culprit splenic tissue is recommended, but not more extensive dissection of non-involved nodules. Our patient presented at 43 years of age with abdominal pain, distention and bilious vomiting. He had undergone a splenectomy at the age of 13 years due to splenic rupture after a motor vehicle collision. Computed tomography demonstrated a small bowel obstruction with multiple nodules suspicious of splenosis. The obstructing mass and compromised bowels. were resected. Final pathology confirmed the diagnosis. Splenosis is an uncommon aetiology of small bowel obstruction and must be considered in patients who had previous splenic trauma or surgery.