Spontaneous rupture and hemorrhage of hepatic focal nodular hyperplasia in lobus caudatus

In general, focal nodular hyperplasia lesions of the liver have a benign natural course; the majority of cases remain asymptomatic and complications are rare. We report a case of spontaneous rupture and hemorrhage of focal nodular hyperplasia, which is extremely rare in the literature. A 35-year-old woman was admitted with severe upper abdominal pain and unstable hemodynamic status. No major abdominal trauma was noted. Radiology findings suggested a diffuse hemoperitoneum. Emergent surgical exploration showed a hemoperitoneum due to the rupture of a hepatic mass lesion in segment I. Suture of the rupture was undertaken with success. After this lifesaving emergent surgery, further investigations, including ultrasound, contrast-enhanced computed tomography, and magnetic resonance imaging, were undertaken, and a 5.7 × 9.8 × 6.4-cm focal nodular hyperplasia lesion was identified in segment I. Two weeks after the first surgical hemostasis, surgical removal of segment I, including the mass, was performed. The postoperative course was uneventful. Pathological evaluation confirmed the nature of focal nodular hyperplasia. The patient remains asymptomatic without evidence of recurrence 3 years and 6 months after surgery. To our knowledge, this is the firstcase of spontaneous rupture and hemorrhage of focal nodular hyperplasia that needed two consecutive surgical operations.