A 38-year-old woman was seen with a hemoperitoneum caused by rupture of a hepatic adenoma of the right lobe. The patient had been taking oral contraceptives for ten years, but discontinued their use three years previously. During the postoperative course a second adenoma of the contralateral lobe, not diagnosed at the first operation, ruptured. The relationship between oral contraceptive use and hepatic cell adenoma is briefly reviewed.
PIP: This article reports the case of a 38-year old woman with 2 hepatic adenomas associated with oral contraceptive (OC) use. At admission, the patient was seen with a hemoperitoneum caused by rupture of a hepatic adenoma of the right lobe. She was menstruating at the time of the onset of symptoms. During the postoperative course a 2nd adenoma of the contralateral lobe, not diagnosed during the earlier operation, ruptured. The patient has been taking OCs (1 mg norethindrone plus 0.08 mg mestranol) for 10 years, but had discontinued OC use 3 years prior to admission. The risk of hepatic adenomas associated with OC use increases with OC dose, duration of use, and age. Discontinuation of OC generally produces partial or complete regression of these tumors. However, this case suggests that hepatic adenoma in former OC users can present a high risk of rupture, especially during menstruation.