Abstract
IntroductionWe report an unusual presentation of a small hepatic cyst causing cholangitis.Case presentationA 70-year-old Asian man was hospitalized for aggravated chronic pain in the right upper portion of his abdomen. Fever developed after admission. Laboratory tests revealed elevated hepatobiliary enzymes, inflammatory markers and carbohydrate antigen 19-9 without hyperbilirubinemia. Ultrasound and computed tomography demonstrated dilatation of the left intra-hepatic bile ducts. Endoscopic retrograde cholangiopancreatography showed that the right intra-hepatic bile ducts were normally filled with contrast medium, but the left intra-hepatic bile ducts were not seen in the confluence. A left hepatectomy was performed because a hidden malignancy could not be excluded. The surgical findings showed no tumor around the bile duct but rather a 2 cm cyst in segment four of Couinaud's category of the liver around the hilum. The pathology report was a solitary non-parasitic hepatic cyst compressing the bile duct.ConclusionA very small solitary hepatic cyst might cause hepatic duct stricture if it is located near the hepatic hilum, and should be considered in the differential diagnosis of a hepatic duct stricture.
Highlights
We report an unusual presentation of a small hepatic cyst causing cholangitis.Case presentation: A 70-year-old Asian man was hospitalized for aggravated chronic pain in the right upper portion of his abdomen
A very small solitary hepatic cyst might cause hepatic duct stricture if it is located near the hepatic hilum, and should be considered in the differential diagnosis of a hepatic duct stricture
These symptomatic Solitary non-parasitic hepatic cysts (SNHC) are usually larger than 10 cm and can cause obstructive jaundice and cholangitis because of their mass effect on the bile ducts
Summary
A small fraction of them are associated with symptoms such as abdominal pain, an abdominal mass, early satiety, nausea, and vomiting These symptomatic SNHCs are usually larger than 10 cm and can cause obstructive jaundice and cholangitis because of their mass effect on the bile ducts. In this case, we present a 70-year-old man with a very small (2 cm) cyst in the hepatic hilum compressing the left hepatic duct. A small hepatic cyst (1.5 × 2.0 cm size) was present, in segment four according to Couinaud’s classification at the level of the transverse fissure, compressing the left hepatic duct (Figure 2) It was confirmed as a solitary benign non-parasitic cyst lined by a single layer of cuboidal epithelium on histological examination (Figure 3). Our patient made an uneventful recovery and at the five-month follow-up, he was asymptomatic and all laboratory findings had normalized
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