The Treatment of Liver Hemangioma Associated with Kasabach-Merritt Syndrome in Neonates.

Shin,  Jung Wook; Lee,  Chul; Namgung,  Ran; Park,  Min Soo; Park,  Kook In

Case Report

Journal of the Korean Society of Neonatology 2005;12(2):179-184.
Published online November 1, 2005.

The Treatment of Liver Hemangioma Associated with Kasabach-Merritt Syndrome in Neonates.

Jung Wook Shin, Chul Lee, Ran Namgung, Min Soo Park, Kook In Park

Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea. lchul63@yumc.yonsei.ac.kr

신생아에서 발생한 Kasabach-Merritt Syndrome을 동반한 간혈관종의 약물적 치료와 혈관 색전술

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Abstract

Hemangioma is the most frequent liver tumor in infancy. The treatment of hepatic hemangioma includes medical, surgical, and non-operative interventional therapy. There are no standard medical regimens currently considered consistently effective. MDMP (megadose methylprednisolone) and alpha-interferon can be used for medical treatment. Interventional occlusion of feeding arteries in symptomatic hepatic hemangioma is considered a safe and effective alternative to early open surgery. Untreated symptomatic patients with heart failure have a high mortality rate. For this reason symptomatic patients with heart failure may require non-operative treatment such as interventional embolization, because hepatic resection is burdened with high risk. We report our experiences of two patients with neonatal liver hemangiomas whose clinical courses were complicated by cardiac failure to whom medical treatment and/or interventional vascular occlusion were done. Both patients had Kasabach-Merritt syndrome complicated with cardiac failure. Initially, the masses were considered unresectable. In one case, we performed interventional therapy in addition to medical treatment. In another case, we tried medical therapy with megadose steroid and alpha-interferon. Unfortunately, in spite of the treatments, the patients died of severe hemorrhage.

Key Words: Liver hemangioma; Kasabach-Merritt syndrome; Megadose Methylprednisolone; alpha-Interferon; Interventional embolization