巨大単純肝嚢胞の腹腔鏡下治療：症例報告

Simple hepatic cysts follow an indolent course and are discovered incidentally on imaging modalities, often requiring no treatment. However, for large hepatic cysts presenting with pressure symptoms, treatment becomes necessary. We present a case of a 51-year-old woman presenting with complaints of progressive swelling over the right upper abdomen for one month, associated with abdominal pain for 15 days. She had undergone percutaneous aspiration for the same pathology previously done at another facility 15 days prior to presentation. Contrast-enhanced computed tomography (CT) revealed a 25x20x17 cm, well-defined, fluid-filled homogeneous cyst occupying the right lobe of the liver. Based on the general physical examination, elevated inflammatory markers such as C-reactive protein (CRP), and imaging findings, a diagnosis of an infected giant hepatic cyst was made. Laparoscopic cyst deroofing was planned. Intraoperatively, percutaneous aspiration of fluid, which yielded approximately 4 L of dirty fluid containing debris, was performed prior to cyst deroofing. The procedure was completed without any complications, and postoperative events were uneventful. This case demonstrates that laparoscopic cyst deroofing can be successfully performed even for large cysts (25x20x17 cm). The key factors determining successful management include careful patient selection, cyst characters, and surgeon-related factors.