Spontaneously ruptured hepatic cyst treated with laparoscopic deroofing and cystobiliary communication closure: A case report

Abstract

The rupture of a nonparasitic hepatic cyst with biliary communication is rare. We report the case of a patient with a hepatic cyst with biliary communication that spontaneously ruptured and was successfully treated by laparoscopic deroofing and closure of the communication. A 61-year-old woman presented at our hospital with a chief complaint of right upper abdominal pain. Enhanced abdominal CT showed a collapsed hepatic cyst and fluid collection. Drip infusion CT cholangiography showed contrast medium pooling in the collapsed cyst. Therefore, hepatic cyst rupture with biliary communication was diagnosed, and laparoscopic deroofing and closure of the communication were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 6. In cases of hepatic cyst rupture, even in the presence of biliary communication, laparoscopic deroofing and closure of the communication should be recommended as the first-choice treatment.

Laparoscopic deroofing of a ruptured hepatic cyst presenting as an acute abdomen

“…This approach might not be suitable for all cases, especially for unstable patients (bleeding or septic), cysts located in the upper and posterior segments of the liver (difficult access) and those with a biliary communication. There are only three other cases reported using laparoscopic surgery as an emergency procedure [1, 3, 9].…”

“…Usually they are asymptomatic and can be managed conservatively, but about 5% of NHCs become large and symptomatic, causing abdominal pain, bloating, nausea, vomiting and dyspnoea. Those becoming symptomatic may require treatment and various procedures have been proposed such as aspiration, sclerotherapy, deroofing, enucleation or hepatectomy [2, 3].…”

“…There are very few cases of NHC rupture reported in the literature, therefore the optimal treatment strategy is yet to be defined [1, 3].…”

Simple hepatic cyst rupture exacerbated by anticoagulation

“…A systematic review by Imaoka et al identified 18 relevant publications (29 cases) on non-parasitic hepatic cyst ruptures between 1959 and 2015 8. We further identified four publications,9–12 making a total of 34 cases (Imaoka included). Eleven of these resulted in haemoperitoneum, but only two were associated with long-term anticoagulation 10 13.…”

Emergency laparoscopy-treated spontaneous bleeding and cystobiliary communication of multiple liver cysts

“…Hepatic cyst combined with bile duct infection was also the most common cause of rupture. 5 Biliary communication, repeated infection of bile in the cyst fluid could easily cause damage to the cyst wall. We also confirmed this phenomenon in this case.…”