Diagnostic and Therapeutic Challenges in Nonparasitic Liver Cysts

Abstract

Nonparasitic hepatic cysts constitute a heterogeneous group of disorders. " proper diagnosis of hepatic cyst is necessary in order to adopt the best treatment. The term hepatic cyst usually refers to simple hepatic cysts. Nonparasitic hepatic cysts are also linked to genetic disorders such as polycystic liver disease PLD with/ without autosomal dominant polycystic kidney disease "DPKD or Caroli disease.Generally, patients with nonparasitic hepatic cysts less than cm are asymptomatic. These cysts become symptomatic when are large, multiple, or complicated.Percutaneous abdominal ultrasound is the best imaging modality to diagnose hepatic cysts but must be completed by other imaging and serological tests. It is important to differentiate simple hepatic cyst from hydatid cyst, cystadenoma, and cystadenocarcinoma before proceeding with the treatment. Sometimes the diagnosis is very challenging. "symptomatic single liver cysts need only surveillance, but symptomatic and complicated ones require therapeutic intervention.Percutaneous aspiration of the cyst under ultrasound guidance is a mini-invasive procedure generally associated with sclerotherapy. The highest success rates were reported for laparoscopic or open cyst fenestration. Liver transplantation is indicated for patients with severe PLD.

Operator-Related Risk Factors of Anastomotic Leaks After Colorectal Surgery: An Up-to-Date

“…An adequate blood flow is essential in the healing process of the suture. A proper vascularization ensures an appropriate intake of nutrients and oxygen and allows the removal of metabolites [ 5 ].…”

“…Most often assessed by the surgeon according to her/his experience, by observing the coloration and the presence of bleeding, or by anatomical knowledge, this method is subjective and imprecise. Bulkley argued that although it has a 90% accuracy in identifying problem cases, it can lead to excessive resection at a rate of 46% [ 5 ].…”

“…Doppler ultrasound is a simple, cheap, fast method, but it was not found to have consistent results [ 5 ]. Its predictive value was comparable with the clinical assessment in most studies, without supplementary benefits.…”