Hemorrhagic hepatic cyst: report of a case and review of the literature with emphasis on clinical approach and management.
OBJECTIVE
Hemorrhage within a hepatic cyst (hemorrhagic hepatic cyst, HHC) is a complication of liver cysts that is difficult to differentiate from other neoplastic entities on imaging. Even when accurately diagnosed, there has been a lack of consensus on the optimal treatment strategy. After presenting our experience with a patient treated via laparoscopy, we aimed to conduct a review of the literature on HHCs.


METHODS
A computerized search in Medline, PubMed, Google Scholar, and The Cochrane Collaboration was carried out for journal articles or abstracts published from 1950 to 2011.


RESULTS
A total of 24 patients with HHCs were identified from 1983 to 2011. The cohort had an even gender distribution with a mean age of 62.7 years. Most patients presented with abdominal pain (80 %), while three (14 %) patients were asymptomatic at the time of presentation. CT imaging and ultrasound were unable to accurately diagnose HHC, whereas hyperintensity on MRI was a reliable diagnostic tool. Three (13 %) patients were managed conservatively with observation. Seven (30 %) patients had percutaneous transhepatic drainage. Among these, two patients experienced recurrence that required repeat treatment. Two (9 %) patients underwent open unroofing of their HHC and one (4 %) laparoscopically, without recurrences. Seven (30 %) patients underwent hepatic resection, whereas six (26 %) patients had a cyst enucleation for their HHCs. All patients had uneventful recoveries, with a mean follow-up of 25 months.


CONCLUSIONS
MRI is a reliable diagnostic tool in the setting of an HHC. Laparoscopic unroofing of HHCs may represent a less morbid and safe treatment modality with low recurrence rates. Given the low level of clinical evidence available so far, these results should be interpreted with caution.
Department of Surgery, Jefferson Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th Floor, Philadelphia, PA 19107, USA.
Zhi Ven
ZV
Fong
Andrea M
AM
Wolf
Cataldo
C
Doria
Adam C
AC
Berger
Ernest L
EL
Rosato
Francesco
F
Palazzo
D000368:Aged; D003560:Cysts / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged