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Introduction: Focal nodular hyperplasia and hepatocellular adenoma are benign hepatic tumors and differential diagnosis is important as hepatic adenomas may complicate with hemorrhage and malignant transformation. Magnetic resonance imaging with gadolinium-enhanced contrast agents is the best noninvasive diagnostic tool for benign hepatic tumors. Nevertheless, atypical radiological findings can make differential diagnosis a challenge. Presentation of case: We report a young female patient with large hepatic benign tumor with intralesional hemorrhage that disclosed hyper-intensity on hepatobiliary phase on a gadolinium-enhanced magnetic resonance imaging study, suggestive of focal nodular hyperplasia. As this type of tumor usually do not complicate with bleeding, surgical resection was proposed and a laparoscopic right posterior hepatic sectionectomy with selective hepatic artery clamping was performed. Pathology disclosed an inflammatory hepatic adenoma. Discussion: Hepatic adenomas may present as hyper-intense tumors on hepatobiliary phase of gadoliniumenhanced magnetic resonance imaging. Surgical resection still has a role on the treatment of benign hepatic tumors. Laparoscopic liver resections must be considered, even when a major hepatectomy is planned, as this approach has proved safe and effective. Selective hepatic artery clamping during minimally invasive liver surgery may be an option to reduce intraoperative bleeding, remnant liver ischemia and postoperative hepatic failure. Conclusion: We reported a young female patient with a benign hepatic tumor complicated with hemorrhage suggestive of a focal nodular hyperplasia on gadolinium-enhanced magnetic resonance imaging study. A laparoscopic hepatectomy was performed and final pathology disclosed an inflammatory hepatocellular adenoma.

Introducao/Objetivos : O Colangiocarcinoma e o segundo tumor hepatico maligno mais prevalente, apresentando prognostico reservado quando nao e passivel de resseccao, ja que esta e sua unica possibilidade de cura. Visando melhores resultados na terapeutica cirurgica, alem de criterios adequados de ressecabilidade, e impreterivel a tecnica cirurgica mais segura e eficaz. Atualmente, observa-se que o uso da Liver Hanging Maneuver (LHM), como componente da tecnica de abordagem anterior (AA) das grandes resseccoes hepaticas, tem conferido a essas, maior viabilidade, ja que permite: menor hemorragia; menor manipulacao e ruptura tumoral; maior estabilidade na manipulacao da Veia Cava Inferior (VCI); reduzido dano isquemico ao figado remanescente e melhor sobrevivencia aos pacientes com tumor hepatico. Relato de Caso: Paciente do sexo feminino, 58 anos submetida a uma trisetorectomia com abordagem anterior e uso da Liver Hanging Maneuver devido a um colangiocarcinoma intrahepatico. Resultados: Boa evolucao pos-operatoria e atualmente esta com dois anos de seguimento ambulatorial. Apresentamos os aspectos tecnicos da “Liver Hanging Maneuver”. Conclusao: Tecnica segura que aumenta a viabilidade das grandes resseccoes hepaticas, principalmente nos casos de tumores intra-hepaticos grandes, como no caso discutido nesse relato. Descritores: Neoplasias hepaticas, Colangiocarcinoma, Carcinoma hepatocelular, Ductos biliares intra-hepaticos; Hepatectomia/metodos Abstract Introduction/Purpose: Cholangiocarcinoma is the second most prevalent hepatic tumor presenting a reserved prognosis when is not amenable to resection, because this treatment is the only possibility of cure. Seeking for better surgical outcomes, beyond of adequate resectability criteria, the safety and most effective surgical technique is fundamental. Nowadays, it is observed that the use of Liver Hanging Maneuver as a component of the anterior approach techinique of large liver resections has conferred to these greater viability, since it allows: less haemorrhage; less tumoral manipulation and rupture; better haemodynamic stability by avoiding any twisting of the inferior vena cava; reduced ischemic damage of the liver remnant, and better survival for patients with hepatic tumor. Case report: 58-year-old patient, female, did submit to a trisetorectomy due to intrahepatic cholangiocarcioma with the use of the Liver Hanging maneuver. Results: Good postoperative evolution and currently has two years follow-up. We introduce the technical aspects of Liver Hanging Maneuver. Conclusion: A safe technique that increases the viability of large hepatic resections, especially in cases of large intrahepatic tumors, as in the case discussed in this report. Keywords: Liver neoplasms; Cholangiocarcinoma; Carcinoma, hepatocellular; Bile ducts, intrahepatic; Hepatectomy/methods