Under the light of medical history and signs on

abdominal examination, the patient was diagnosed as having acute appendicitis with a Mantrels score of 6 and was taken to theatre for appendectomy. At operation a normal appendix was found. At further exploration, a large soft reddish mass was palpated near the caecum. Macroscopically, the mass measured 10 × 12 × 15 cm. It was connected to the right inferior margin of the liver with a thin pedincule. It had undergone a 360° clockwise torsion click here on its pedincule. The mass was easily detorsioned and resected (Fig 1 and 2). Appendectomy was also performed using the routine method. Histologic assessment confirmed a cavernous hemangioma. The mass had multiple vascular spaces and fibrosis and was unusual for that

there was a considerable amount of adipocytes intermingling within the tumor (Fig 3). The patient’s recovery was uneventful, and he was discharged on the 2nd postoperative day. Figure 1 Pedinculated hemangioma on the operation table; black arrow points the pedincule. Figure 2 Resected hemangioma; arrows point PCI-32765 nmr the pedincule. Figure 3 Histopathologically the lesion composed of large vessels with cystically dilated lumina and thin walls. Lumen of blood vessels is filled with erythrocytes.(H+E). Discussion Cavernous hemangioma is the most common benign tumor of the liver. They are probably of congenital origin and have no potential for malignant transformation. Protein Tyrosine Kinase inhibitor Most are diagnosed incidentally and are asymptomatic. Hemangiomas are usually found at the right lobe of the liver in a subcapsular or marginal location. Most hemangiomas are diagnosed incidentally and are small and asymptomatic. Their size usually remains stable and can vary from a few milimetres to more than 20 cm. Lesions larger than 4 cm have been defined as giant hemangiomas [3]. Giant hemangiomas

may cause abdominal discomfort, swelling, abdominal pain, icterus and thrombocytopenia [4]. Very rarely, spontaneous rupture with intraabdominal hemorrhage may create acute abdominal symptoms, which may also occur after rupture due to blunt abdominal trauma. Surgery is the treatment of choice, especially for giant, symptomatic hemangiomas with uncertain diagnosis. Rarely, hemangiomas can be pedunculated [5]. At ultrasound, the origin of the lesion may be difficult to recognize. The lesion can be attached to the liver with a thin pedicle, which is nearly undetectable at imaging. If they undergo torsion due to their long, mobile pedincule and get infarcted, they may become symptomatic. Pain is the most frequent symptom and most likely occurs from infarction or pressure on surrounding tissues. They can seldom cause pressure symptoms or get ruptured. Definite diagnosis should be made to distinguish it from other causes of acute abdominal pain.