A 32-year-old woman on combined oral contraceptives for 8 years presents with sudden severe right upper quadrant pain and hypotension. CT shows a 7 cm exophytic lesion in the right lobe of the liver with free intraperitoneal blood. After resuscitation, the most appropriate definitive management is:
- A Surgical resection of the lesion ✓
- B Transarterial embolisation followed by lifelong observation without resection
- C Liver transplantation
- D Percutaneous aspiration and catheter drainage
Correct answer: A. Surgical resection of the lesion
Explanation
Hepatocellular adenoma larger than 5 cm, or any symptomatic adenoma, carries a significant risk of haemorrhage and malignant transformation to hepatocellular carcinoma, and resection is advised. This patient has already bled, mandating definitive resection once stabilised. Embolisation alone is a temporising measure for active bleeding or an unresectable lesion, not definitive therapy here. Percutaneous drainage of a solid tumour bleed is inappropriate, and transplantation is reserved for diffuse adenomatosis or unresectable malignant transformation.
Reference: Sabiston Textbook of Surgery, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.