title: Intraoperative air leak test was useful for the detection of a small biliary fistula: A rare case of non-parasitic hepatic cysts with biliary communication.
abstract: BACKGROUND
  Symptomatic non-parasitic hepatic cysts with biliary communication are rare and no standard treatment has been established yet. Careful attention should be paid to avoidance of postoperative bile leakage during surgical treatment.
  
  
  METHODS
  We report the case of a 74-year-old man who visited our department complaining of right upper abdominal pain and elevated serum levels of the liver enzymes. Computed tomography revealed hepatic cysts including a large one measuring 16cm in diameter in Segments IV and VIII. Percutaneous drainage of the cyst revealed bile-staining of the cyst fluid. Endoscopic retrograde cholangiography demonstrated the presence of a cyst-biliary communication. We performed open deroofing of the cyst. During the operation, the biliary fistula was invisible, however, air injection into the bile duct through the stump of the cystic duct caused release of air bubbles from the cyst cavity, which allowed us to detect the small biliary orifice and repair it successfully by suture.
  
  
  CONCLUSIONS
  We utilized the intraoperative air leak test, which has previously been reported to be effective for preventing postoperative bile leakage in patients undergoing hepatectomy to detect of a small cyst-biliary communication in a case undergoing non-parasitic hepatic cyst surgery.
  
  
  CONCLUSIONS
  An intraoperative air leak test may be a useful test during surgical treatment of non-parasitic hepatic cysts with biliary communication.
authors.affiliation: Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan. Electronic address: atsushishimizu1214@hotmail.com.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan.
authors.forename: Shojiro
authors.initials: S
authors.lastname: Hata
authors.affiliation: Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Teruya
authors.affiliation: Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Kaminishi
keywords: Air leak test; Bile leakage; Biliary communication; Hepatic cysts; Surgery