Rupture of a Hepatic Hemangioma in the Remnant Liver Following Hybrid Extended Left Hemihepatectomy in a Living Liver Donor: A Case Report

INTRODUCTION: Hepatic hemangiomas have occasionally been identified in donor liver grafts. However, rupture of a hemangioma in the remnant liver following liver graft harvest in a living donor has not been documented. CASE PRESENTATION: A 41-year-old male underwent hybrid extended left lobe graft harvesting as a living liver donor for his brother, who had hepatocellular carcinoma and alcohol-induced decompensated liver cirrhosis. Preoperative contrast-enhanced CT revealed a 22-mm hemangioma in segment 6 of the donor liver. Postoperatively, the donor experienced a gradual progression of anemia. On POD 3, contrast-enhanced CT demonstrated an intrahepatic hematoma with active contrast extravasation due to rupture of the hemangioma in the right posterior segment, compressing the right portal vein branch. Emergency surgery was performed, and a large subcapsular hematoma was found on the liver surface. After opening the hepatic capsule, hematoma evacuation, bleeding source identification, and hemostasis were performed. The patient had an uneventful recovery and was discharged home on POD 8. CONCLUSIONS: This is the first case report of hepatic hemangioma rupture in the remnant liver after graft harvest in a living liver donor.