Emergency cesarean delivery followed by extended left hepatectomy and right hepatic hemangioma enucleation for giant hepatic hemangioma with intratumoral hemorrhage in late pregnancy: a case report

Management of giant hepatic hemangioma (HH) complicated by intratumoral hemorrhage in late pregnancy is rarely reported and remains particularly challenging because maternal hemorrhagic compromise and fetal safety must be addressed simultaneously. We report the case of a 36-year-old gravida 2 para 1 woman at 33 weeks and 5 days of gestation who was admitted after a heterogeneous abdominal mass was detected on routine prenatal ultrasonography. Contrast-enhanced computed tomography (CT) demonstrated a giant lesion in the left hepatic lobe that was considered most consistent with HH complicated by intratumoral hemorrhage and an additional hemangioma in the right hepatic lobe, and laboratory testing revealed severe anemia and hypoalbuminemia. After blood transfusion, albumin supplementation, and multidisciplinary evaluation, the patient underwent emergency cesarean delivery followed by extended left hepatectomy and enucleation of the right hepatic hemangioma. Both the mother and the neonate recovered uneventfully, and no significant abnormalities were noted during 1 month of follow-up. This case highlights that in late pregnancy complicated by hemorrhagic giant HH, early recognition, rapid multidisciplinary decision-making, and timely combined obstetric and hepatic intervention may be lifesaving and can achieve favorable maternal and neonatal outcomes.