Jaundice caused by protrusion of a hepatic cyst into common bile duct that was resolved by choledochoscopic needle-knife electrotomy: a case report

Abstract

BackgroudHepatic cysts are the most frequent, innocuous, space-occupying lesions of the liver. The majority of solitary liver cysts are nonsymptomatic. When liver cysts reach a large size, there are some complications, including infection, rupture, spontaneous hemorrhage, obstructive jaundice, and neoplastic degeneration. Percutaneous aspiration, fenestration, hepatic resection, and liver transplantation have been proposed for symptomatic patients.Case presentationIn this case report, we describe a 41-year-old woman who presented with persistent liver dysfunction, indolent xanthochromia, and skin itching for 3 months. After a series of tests, she has a 5.0 × 5.3 cm hepatic cyst with many separations in the left medial liver lobe. The obstructive jaundice was caused by a large pedunculated lump protruding into the common bile duct from the left hepatic duct. She was treated with laparotomy and this lump was completely removed from the root by choledochoscopic needle-knife electrotomy with a good clinical response. Postoperative pathology of the lump suggested a hepatic cyst wall without heterocysts or tumor cells.ConclusionHepatic cyst wall protruding into the common bile duct can form capsular lump and result in indolent jaundice. Choledochoscopic high-frequency needle-knife electrotomy could be considered as a simple, safe and effective complementary approach for benign mass on the bile duct wall.

Percutaneous aspiration and sclerotherapy of a giant simple hepatic cyst causing obstructive jaundice: A case report and review of literature

“…Obstructive jaundice caused by solitary simple liver cysts is quite rare. A total of 17 cases of simple or benign liver cysts accompanied by obstructive jaundice were reviewed (Table 1 )[ 17 - 33 ]. The average age of the patients was 65.2 years old, with a 7:10 female to male ratio.…”

“…In recent years, a combination of drainage, sclerosing agent injection, and deroofing seem to be the most common treatment methods. Choledochoscopy was also proven to effectively treat these patients[ 33 ]. In our patients, the giant liver cyst caused obstructive jaundice and dilatation of the intrahepatic bile duct of the left lateral segment of the liver, which largely accounted for the patient’s symptoms.…”

Prevention and correction of postdecompression liver dysfunction in obstructive jaundice in experimental animals

“…При билиарной декомпрессии имеет место механическое сдавливание междольковых артерий, вен и лимфатических сосудов расширенными желчными протоками и окклюзия русла капилляров [2,18]. При полной обтурации билиарного дерева происходит расширение всей системы желчевыводящих протоков, образование тромбов, набухание выстилки синусоидов, пролиферация эпителия ворсинок желчных протоков, что приводит к развитию оксидативного стресса и деструкции эндотелия сосудов с последующим развитием ишемии -реперфузионного синдрома [4, 21,37,38]. А реперфузионный синдром, в свою очередь, выступает фактором развития печеночной недостаточности после восстановления проходимости желчных протоков [7,26].…”