Simple hepatic cyst is not always simple - a case report of cystobiliary communication requiring hepatic resection
Chin-Yee Mah1, Chang-Kuo Wei1, Chun-Hung Lin1,2
1Department of General Surgery, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan.
Background:
Simple hepatic cysts are common and usually asymptomatic, but rarely may communicate with the intrahepatic biliary tree; unroofing alone can then result in postoperative bile leakage if this communication is not recognized.
Case Presentation:
We report a 74-year-old woman with multiple hepatic cysts, the largest measuring 11 cm and causing extrinsic gastric compression. Preoperative computed tomography (CT) suggested a simple cyst without evidence of biliary communication, and laparoscopic unroofing was planned. Needle decompression, however, yielded bile-like fluid indicating unsuspected cystobiliary communication; the procedure was therefore converted to laparoscopic left lateral sectionectomy. Her postoperative course was uneventful, without bile leakage.
Conclusion:
In conclusion, a preoperatively "simple" hepatic cyst may harbor unsuspected cystobiliary communication that CT alone can miss. Intraoperative vigilance and willingness to convert to formal resection are essential when this complication is encountered.
