Laparoscopic resection of a congenital liver cyst and simultaneous closure of a diaphragmatic defect in a 5-month-old infant.
Congenital liver cysts are an unusual finding and present a difficult diagnostic challenge. In a 5-month-old infant, routine echocardiography detected a cystic lesion (3 cm in diameter) just below the diaphragm. All conventional diagnostics, including magnetic resonance imaging (MRI), failed to clarify its etiology definitively. Moreover, a phrenic irregularity was suspected at the site of Morgagni. Finally, laparoscopy (5-mm scope and instruments) confirmed the diagnosis of a solitary liver cyst and a diaphragmatic defect. Using a Harmonic scalpel, the cyst was resected and the diaphragmatic defect was closed with interrupted nonabsorbable sutures. The patient's postoperative course was uneventful. Pathological analysis showed a true liver cyst with mesothelial lining and hepatic residues. Retrospective speculation suggests a common embryologic origin for both malformations. In conclusion, laparoscopy allowed final diagnosis and simultaneous treatment of an infant with the rare combination of a liver cyst and a diaphragmatic defect. To our knowledge, this case represents the first endosurgical experience of such a simultaneous procedure.
Till
H
H
Department of Pediatric Surgery, Children's Hospital, University of Munich, Lindwurmstrasse 4, D-80337 Munich, Germany. holger.till@kk-i.med.uni-muenchen.de
Schuster
T
T
Boehm
R
R
Pfluger
T
T
Döhlemann
C
C
Joppich
I
I
D003560:Cysts / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006548:Hernia, Diaphragmatic / Q000175:diagnosis; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008107:Liver Diseases / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*