Neonatal hepatic hamartoma requiring emergency hepatectomy: A case report

Abstract

Introduction: Mesenchymal hamartoma is the second most common benign tumor of the liver in childhood, is observed mainly in children under 2 years and affects more frequently the right lobe. It predominates in males and the etiology is unknown. In neonates, the tumor may have a rapid growth, causing decompensation in these patients. Case presentation: A seven-day-old male presented with abdominal distension, dyspnea and marked pallor. Laboratory test showed normal transaminases, mildly elevated bilirubin, and normal alpha-fetoprotein. Magnetic resonance imaging demonstrated a cystic liver tumor involving segments V, VI, VII and VIII with extension to the right iliac fossa. The patient developed hemodynamic decompensation requiring ventilatory support. Emergency surgery was decided and a right hepatectomy was performed. In our procedure we were able to ligate and divide the vascular components before beginning the parenchymal transection. We used an ultrasonic dissector to achieve adequate hemostasis during transection and we checked for possible bile leaks at the end of the procedure. The patient remained hospitalized for approximately 7 weeks. The pathological diagnosis was hepatic mesenchymal hamartoma with tumor-free margins. Conclusion: Hepatic mesenchymal hamartoma in the neonatal stage may present rapid growth leading to severe complications. Surgical resection is the standard for diagnosis, as well as treatment. Our patient is one of the few reported cases of hepatectomy in a newborn less than 15 days old with a successful outcome.

Keywords

• Case report
• Hamartoma
• Liver
• Newborn
• Hepatectomy