Hepatic Hemangioma Complicated by Kasabach\u00002013Merritt Syndrome Diagnosed with Predominantly Hyperfibrinolytic Type Disseminated Intravascular Coagulation

Abstract

A 68-year-old woman was found to have a 24-cm-diameter hepatic hemangioma in the left liver lobe and ventral side of the anterior segment. Laboratory examination showed a coagulation abnormality, and hepatic hemangioma complicated by Kasabach-Merritt syndrome (KMS) was diagnosed. The patient was referred to our department for liver resection. Hyperfibrinolytic type disseminated intravascular coagulation was diagnosed based on a prolonged bleeding time and increased concentrations of thrombin-antithrombin complex and plasmin-α2 plasmin inhibitor complex. Therefore, a continuous infusion of nafamostat mesylate was given as antifibrinolytic therapy in the perioperative period. Extended left hemi-hepatectomy under good bleeding control was performed compared with previously reported cases of hepatic hemangiomas in patients with KMS. No bleeding or thrombotic complications occurred postoperatively, and the patient was discharged from the hospital in good clinical condition. Therapeutic selection taking into account the disseminated intravascular coagulation classification based on the patient's fibrinolytic condition may be a new approach to reducing the bleeding risk in patients undergoing liver resection for hepatic hemangiomas complicated by KMS.