Primary abdominal herniation of hepatic cyst

The patient is an 86-year-old woman with a history of DM2, hypertension, severe heart failure and AF, under treatment with acenocoumarol, who came to the emergency room for a painless abdominal tumor with no signs of infection, located in the right hypochondrium, with no history of trauma or previous surgery. Laboratory tests showed: leukocytosis 23 000, neutrophilia 85%, prothrombin activity 15% and INR 4.5. Abdominal CT revealed an anterior perihepatic cystic lesion measuring 15 × 15 × 8.5 cm that was polylobulated and passed through the right anterolateral abdominal wall, with no signs of complications or bleeding (Fig. 1). Cystic fenestration and laparoscopic hernioplasty were proposed, which the patient rejected due to age and comorbidity. Outpatient follow-up was decided.

Figure 1

Diagnosis: giant liver cyst herniated through a primary defect in the right anterolateral abdominal wall.