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INTRODUCTION: Hepatic hemangioma (HH) is the most common benign neoplasm affecting the liver. Most cases are asymptomatic and incidentally found at imaging studies. Giant hepatic hemangiomas are uncommon, but pedunculated giant hemangiomas are even rarer, making their clinical and imaging diagnosis a challenge for the surgeon. PRESENTATION OF CASE: Herein; we report the case of a 26-year-old male patient, who presented to the emergency ward with acute abdominal pain associated with a palpable mass, mimicking a complicated appendicular plastron, additionaly were found it liver enzymes elevated. Then the patient was taken the operating room. An exophytic pedunculated liver tumor that projected towards the right iliac fossa was identified. It had undergone torsion on its pedicle. Transfixing hemostatic sutures were placed, proceeding with its exeresis. The patient tolerated the procedure and was discharged without complications on the third postoperative day. Pathological anatomy confirmed the diagnosis. DISCUSSION: Giant pedunculated HH is an infrequent entity that generates mass effect on intra-abdominal organs causing pain depending on its location. In our case, HH size was 13 cm with elevated liver enzymes, only previously reported in one case of a 20-cm hemangioma. Surgery is indicated for cases of giant and symptomatic lesions. CONCLUSION: Torsioned pedinculated giant liver hemangioma may be part of the differential diagnosis of a patient with acute appendicitis with elevated liver enzymes. The elevation of liver enzymes may be related to the size of the HH.

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RESUMEN El objetivo del presente artículo es brindar sugerencias, para el manejo pre, intra y posoperatorio, de pacientes de cirugía general, durante la emergencia sanitaria por COVID-19; y con ello, minimizar el contagio de cirujanos y disminuir la transmisión intrahospitalaria de la enfermedad. Se realizó una revisión de la literatura a través de PubMed y se consultaron las páginas web de sociedades científicas internacionales, así como, fuentes del Ministerio de Salud del Perú. Se formularon sugerencias para el manejo de estos pacientes, basadas en la experiencia de países donde se tiene un mayor número de casos de COVID-19. Se resalta la importancia del uso adecuado de los equipos de protección personal (EPPs); y la factibilidad de realizar un abordaje abierto o laparoscópico en cirugías de emergencia con los cuidados adecuados para evitar contagios en el paciente y personal de salud. Sin embargo, se debe considerar que las recomendaciones pueden cambiar con el tiempo al generarse nuevos conocimientos.

ABSTRACT The objective of this paper is to present suggestions for the preoperative, intraoperative, and postoperative management of general surgery patients during the COVID-19 health emergency, aiming to minimize risks for surgeons and to reduce in-hospital transmission of SARS-CoV-2. We reviewed the literature using the PubMed database and we also reviewed websites from international scientific societies and the Peruvian Ministry of Health website. Suggestions for the management of surgical patients are proposed, based on the experience of countries with larger numbers of COVID-19 cases. We emphasize the importance of the adequate use of personal protective equipment (PPE), and the feasibility of using an open or laparoscopy approach in emergency surgical procedures, taking adequate care in order to avoid viral transmission for both the patient and healthcare personnel. Nonetheless, we must consider that recommendations may vary with time as new knowledge is acquired.