Laparoscopic Liver Resection for Hepatic Adenoma in Pregnancy

Introduction: Liver cell adenomas (LCA) can present during pregnancy with abdominal pain and bleeding. Assessment and management at this time are complicated by concerns over fetal well-being. Methods: We reviewed cases from our own institution, including the only laparoscopic liver resection reported in pregnancy, and systematically reviewed the literature to identify successful management strategies for this clinical dilemma. Results: Two cases of surgery for bleeding liver adenoma were identified in our own institution. One case was managed with an elective laparoscopic segmental resection at 16 weeks and 1 with open surgery and successful fetal delivery at 32 weeks gestation. In the second case hepatic rupture of a 3.5-cm lesion was precipitated by diagnostic biopsy. In the world literature, spontaneous rupture of an LCA during pregnancy has been reported in 19 cases and is associated with maternal mortality and fetal loss approaching 50%. Conclusions: We advocate an aggressive approach to management of LCA in pregnancy owing to the high mortality associated with rupture. Biopsy of LCA in pregnancy is unsafe and can be complicated by rupture. Hence, patients presenting de novo with clinical or radiologic signs of bleeding or large (> 5 cm) undiagnosed lesions should be offered laparoscopic resection if feasible.