title: Biliary obstruction due to a huge simple hepatic cyst treated with laparoscopic resection.
abstract: Most hepatic cysts are asymptomatic, but complications occasionally occur. We describe a patient with biliary obstruction due to a huge simple hepatic cyst treated with laparoscopic resection. A 60-year-old Japanese woman was admitted to our hospital because of a nontender mass in the right upper quadrant of the abdomen. Laboratory tests revealed the following: serum total bilirubin, 0.6 mg/dL; serum aspartate aminotransferase, 100 IU/L; serum alanine aminotransferase, 78 IU/L; serum alkaline phosphatase, 521 IU/L; and serum gamma glutamic transpeptidase, 298 IU/L. Abdominal computed tomography, ultrasonography, and magnetic resonance cholangiopancreatography revealed a huge hepatic cyst, 13 cm in diameter, at the hepatic hilum, accompanied by dilatation of the intrahepatic bile duct and obstruction of the common bile duct. We diagnosed biliary obstruction due to a huge hepatic cyst at the hepatic hilum, and laparoscopic surgery was performed. A huge hepatic cyst was seen at the hepatic hilum. After needle puncture of the huge cyst, the anterior wall of the cyst was unroofed, and cholecystectomy was done. Intraoperative cholangiography through a cystic duct revealed stenosis of the duct. Subsequent decapsulation of the cyst was performed in front of the common bile duct. After this procedure, cholangiography revealed that the stenosis of the common bile duct had resolved. Histopathological examination of the surgical specimen confirmed the hepatic cyst was benign. The postoperative course was uneventful, and the results of liver function tests normalized. The patient was discharged 7 days after operation. Computed tomography 3 months after operation revealed disappearance of the hepatic cyst and no dilatation of the intrahepatic bile duct.
authors.affiliation: Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. hiroshiy@nms.ac.jp
authors.forename: Yohei
authors.initials: Y
authors.lastname: Kaneya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsutani
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirakata
authors.forename: Akira
authors.initials: A
authors.lastname: Matsushita
authors.forename: Seiji
authors.initials: S
authors.lastname: Suzuki
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maruyama
authors.forename: Koji
authors.initials: K
authors.lastname: Sasajima
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D049448:Cholangiopancreatography, Magnetic Resonance; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D003560:Cysts / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008107:Liver Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D008875:Middle Aged; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed