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RECURRENT GIANT LIVER CYST: A CASE REPORT
Juliana Pava De Los Rios
*, Bryan Gregory, Neil Nagaria
Internal medicine, Community Medical Center, Toms River, NJ
Introduction:Liver cysts have an incidence of 15%-18% in the US (1), most of them are asymptomatic (2) but treatment is necessary in malignant cystic tumors, cystic hemorrhage, infection or giant cysts due to compression of peritoneal organs (2). After intervention the risk of recurrence is 10 to 25% (3).
Simple cysts are characterized by being thin walled, fluid filled, and epithelium lined cavities(4), large cysts are more common in women with a female to male ratio of 4:1. (4) Symptoms from simple cysts occur in 5% of patients and are related to the compression of adjacent structures, not to the cyst itself. (4)
Case description:A 79-year-old female with a recent admission due to hepatic cyst drainage 2 weeks prior; comes into the ED due to abdominal distension and pain that started 2 days before. In the ED found to have ALT at 43, AST 37, bilirubin 1.4 and alkaline phosphatase 401. CT abdomen showed multiple hepatic cysts, with large cyst in the left liver lobe with a diameter of up to 25.5 cm. Patient taken to IR drainage, US guided percutaneous aspiration yielding 4.26 L of cloudy tan-colored fluid, cytology was negative for malignant cells and consistent with cyst contents (scattered neutrophils, lymphocytes and macrophages). Patient was discharged and scheduled for elective laparoscopic cyst fenestration, pathology from the biopsies showed fragments of benign simple biliary cyst. Currently patient doing well, last CT done 1 month after surgery with evidence of cyst within the left liver lobe of 5.6 cm x 5.3 cm, patient is asymptomatic.
Discussion:The incidence of hepatic cysts can range from 5% on US and up to 18% on CT (4) and are commonly incidental findings (5) unless the cyst is large enough to be associated with compression of structures. (4)
There is lack of trials and long term follow ups for management of liver cysts (4), the most immediate treatment for reliving symptoms is US guided percutaneous drainage of the cyst, but recurrence is almost certain. (4) As definitive treatment open or laparoscopic fenestration provides long term relief is up to 90% of the patients. (4)
In the case described the patient had a laparoscopic fenestration done after the drainage which led to her being symptom free with significant improvement in her quality of life. It is important to follow up about 6 to 12 after surgery. (3)
Conclusion:Simple liver cysts are somewhat common and usually have minimal clinical implication but when they start to affect the adjacent organs, symptoms appear due to compression. This case shows one of the biggest simple hepatic nonparasitic cysts recorded and shows a fast recurrence for the patient. It is important to have in mind that if the symptoms do not disappear after the drainage there may be another pathology causing the symptoms and it is important to follow up on the symptoms expressed by the patients.
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