Spontaneous Rupture of a Simple Hepatic Cyst: Report of a Case

Abstract

We describe the spontaneous rupture of a simple hepatic cyst. A 62-year-old woman was admitted for right upper quadrant pain of sudden onset. The patient denied a history of abdominal trauma. Computed tomography of the abdomen showed a 13-cm-diameter solitary hepatic cyst in the right lobe. Part of the cyst surface was irregular, and the internal echo was heterogeneous. Retained fluid was detected under the liver capsule. Ten days after admission, computed tomography revealed that the volume of fluid retained under the liver capsule had decreased but that the hepatic cyst had enlarged again. The patient was referred to our hospital for further evaluation and treatment. Physical examination revealed mild right upper quadrant pain, but no signs or symptoms of peritonitis or abnormalities of the chest or heart. Percutaneous puncture was performed with a needle and an 8-French pigtail catheter under ultrasonographic guidance. Brown serous fluid was aspirated. After the removal of approximately 1,000 mL of fluid, contrast medium was injected to check for communications between the cyst and the biliary tree and to document the absence of leakage into the peritoneal cavity. After complete aspiration of the cyst fluid, 200 mg of minocycline hydrochloride dissolved in 10 mL of saline was injected into the cyst, and the catheter was flushed with 10 mL of saline (total volume of saline, 20 mL). The catheter was then clamped for 30 minutes. After percutaneous aspiration, the patient's symptoms resolved. Minocycline hydrochloride was injected daily for 7 days, and the catheter was removed. There has been no evidence of recurrence after 2 years. (J Nippon Med Sch 2015; 82: 113 116)

Traumatic rupture of a non-parasitic simple hepatic cyst presenting as an acute surgical abdomen: Case report

“…In contrast, ruptures of non-parasitic simple hepatic cysts are rare and can be spontaneous or caused by infection, trauma, or iatrogenic injury [1]. Only 21 English publications that describe ruptures of non-parasitic simple hepatic cysts were published in PubMed from 1974 to 2019 [1,[3], [4], [5], [6], [7], [8], [9], [10], [11],[13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23]] (Table 1). Traumatic rupture of a non-parasitic simple hepatic cyst, as occurred in our patient, is very unusual.…”

“…Percutaneous needle aspiration, however, should be considered only after eliminating the possibility of a malignant or infectious etiology or a cystobiliary communication. Although this treatment is associated with a high (>80%) rate of recurrence, the likelihood of recurrence can be reduced by about 20% when percutaneous needle aspiration is combined with injection of a sclerosing agent, such as minocycline hydrochloride or tetracycline chloride, as these agents promote coagulation-induced necrosis of the cyst epithelium and effectively obliterate cysts [1,7].…”

“…These cysts are usually asymptomatic, allowing conservative follow up without specific treatment [5,6]. Some of these cysts, however, are associated with complications such as infection, hemorrhage, obstructive jaundice, portal hypertension, and rupture [[7], [8], [9], [10], [11]]. There have been few reports describing the rupture of non-parasitic simple hepatic cysts [1,3,[8], [9], [10], [11]].…”

Congenital hepatic cyst with intracystic hemorrhage

“…[14] Surgical approaches include laparoscopy and open cyst fenestration, liver resection, and liver transplantation. [15] Hotta et al [16] and Poggi et al [17] each reported 1 case of spontaneous rupture of a huge hepatic cyst. In the present study, the 2 patients had obvious symptoms and were at risk of cyst rupture.…”