Laparoscopic Approach in a Rare Symptomatic Simple Hepatic Cyst: A Case Report

Abstract

Purpose: Hepatic cysts are formations of liquid content with multiple histological types that differ from each other due to their etiology, symptoms, and clinical management. Specifically, simple cysts are commonly asymptomatic and only require clinical observation. In particular, jaundice is a very rare clinic in these patients. Our goal is to show a case of a simple hepatic cyst that caused jaundice and needed surgery in order to emphasize how infrequent the case is. Methods: We present a descriptive study based on a case of a simple liver cyst that required surgery through a laparoscopic approach. Results: A 79-year-old woman had consulted to the Emergency room due to jaundice for 15 days. The blood test that was carried out showed elevated total bilirubin (12mg/dL) and transaminases levels with a cholestatic pattern, without alterations in the hemogram or elevation of acute phase reactants. An abdominal computerized tomography (CT) and a cholangioresonance revealed dilation of the intrahepatic bile duct secondary to a large cystic lesion in the right lobe of the liver, which measured approximately 10 centimetres. She underwent laparoscopic surgery, unroofing the cyst and the following day the patient was discharged from hospital without jaundice or any surgery complication. Finally, the anatomopathological study demonstrated a simple hepatic cyst, so the woman did not require more periodic controls. Conclusion: Simple liver cysts rarely cause symptoms and only require clinical observation. However, it is very important to perform an adequate anamnesis and carry out the necessary complementary tests to confirm such a diagnosis, since they can be confused with other liver cysts. Some examples might be a hydatid cyst or even a cystadenoma, which has the capacity to become malignant and require more aggresive management. In these patients, if surgery is needed, laparoscopy is a suitable approach, as allows the total resection of the lesion and provides an early postoperatory recovery.