Giant simple hepatic cyst, when and how to treat it

Introduction and Objective

Hepatic cysts are rare, with a prevalence between 0.1 to 0.5%. They are divided into parasitic and non-parasitic, being more common than the last ones. They can be subdivided into simple (<5% of the population) or multiple.

Case Report

46-year-old woman with no relevant history. She comes due to an increase in abdominal perimeter of 4 months of evolution and weight loss of 9kg in 4 months; asthenia, adynamia, early satiety, postprandial fullness and abdominal pain in the right upper quadrant, oppressive, intensity 9/10, exacerbated by mobilization. CT scan with a giant liver cyst of 219 × 166 × 239mm, a volume of 4544cc. Alkaline phosphatase and GGT >3 times their normal value. She was admitted for percutaneous drainage placement, with a total output of 7480cc and biochemical and clinical improvement, without complications.

Discussion

Simple cysts occur in people over 40 years of age, more frequently in women (4:1 ratio). The differential diagnosis includes liver abscess, tumor, hemangioma, hematoma, parasitic cyst, and polycystosis. They are easy to distinguish by image as they are well-defined; they contain serous fluid and lack septa, papillary projections, and calcifications. They are considered giants when measuring>5 cm and their treatment is only indicated in symptomatic patients, with pain being the usual. Percutaneous drainage has little morbidity and improves compression symptoms. However, recurrence is high (almost 100%), so the administration of a sclerosing agent is recommended.

Conclusions

Conservative procedures have high recurrence rates, so systematized laparoscopic surgery is a good option for definitive treatment.

Funding

The resources used in this study were from the hospital without any additional financing

Declaration of interest

The authors declare no potential conflicts of interest.