Abstract
Simple liver cysts occasionally cause pressure symptoms of the abdomen. We herein report an extremely rare case of spontaneous rupture of simple liver cysts. A 65-year-old woman suffered abdominal fullness and dyspnea. Laboratory examinations revealed general inflammation and mild hepatorenal dysfunction. Computed tomography revealed giant polycystic liver and ascites. Echinococcus antibody was not detected. Abdominal paracentesis provided dark brown transparent ascites in which any parasites or tumor cells were not observed. We diagnosed spontaneous rupture of isolated polycystic liver disease (PCLD) and continuously drained the ascites. After the symptoms and laboratory data were improved, resection of liver cysts and left lateral segmentectomy were performed. Histopathologically, simple columnar epithelia inside of cyst walls were observed. The patient remains well without recurrence of the symptoms 10 months after the surgery. We reviewed characteristics of PCLD and considered appropriate treatment for spontaneous rupture of simple liver cysts based on the previous case reports including the present case.
Highlights
Simple liver cysts occasionally cause pressure symptoms of the abdomen and require decompression
We report an extremely rare case of spontaneous rupture of multiple and giant liver cysts, followed by a review of the literature
polycystic liver disease (PCLD) is a different disease from autosomal dominant polycystic kidney disease (ADPKD), tends to have greater and larger cysts and cause pressure symptoms more often than ADPKD, and provides better response to surgical reduction than ADPKD
Summary
Simple liver cysts occasionally cause pressure symptoms of the abdomen and require decompression. General inflammation, and hepatorenal dysfunction were improved (oxygen saturation, 97 %; leukocyte count, 5920/μl; C-reactive protein level, 6.17 mg/dl; total bilirubin, 0.56 mg/dl; direct bilirubin, 0.17 mg/dl; creatinine, 0.56 mg/dl) Her weight and body mass index downed to 82 kg and 38.5, respectively. Palliative reduction is thought to be appropriate for pressure symptoms of simple liver cysts [1], but marsupialization or percutaneous drainage may be insufficient, and more invasive procedures such as cystic wall resection and hepatectomy may be recommended to prevent the recurrence of the symptoms. We temporarily carried out percutaneous drainage of the ascites to relieve dyspnea and performed surgical reduction of the liver cysts after general condition was improved and favorable outcome was obtained
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