PICTURES IN DIGESTIVE PATHOLOGY

Polycystic liver disease

Poliquistosis hepática

J. Campos Franco, E. Otero Antón, E. Gamborino Caramés¹, J. Martínez Castro¹ and E. Varo Pérez¹

Departments of Internal Medicine and ¹General Surgery. Complejo Hospitalario Universitario de Santiago de Compostela. A Coruña, Spain

Case report

A 57-year-old woman with a past history of serous ovarian cystadenoma was admitted to hospital complaining of progressive abdominal bloating for the last six months. Physical examination revealed an increase in abdominal perimeter. The rest of the physical examination was normal. Alkaline phosphatase and gamma-glutamyl-transpeptidase were marginally raised, while the rest of the liver function panel was normal. An abdominal contrast-enhanced computerized tomography (CT) scan (Figs. 1 and 2) demonstrated polycystic liver disease with a giant cyst (22 x 19 cm) and a right kidney that was pushed towards the pelvis. Serologic tests for echinococcal antigens were negative. The giant cyst was aspirated under laparoscopic guidance with 5 liters of clear fluid withdrawn. A laparoscopic fenestration was performed without complications. Cystic fluid cultures were negative. A histopathological analysis of wall fragments confirmed the typical findings in a simple cyst. Currently, the patient is asymptomatic.

Discussion

Polycystic liver disease is rare, with an estimated incidence below 0.01% (1). Patients are usually asymptomatic, but most frequent symptoms include abdominal pain, early satiety, and nausea and vomiting. These symptoms are indicative of significant hepatic enlargement or complications (rupture, bleeding or infection). In selected cases, laparoscopic fenestration can be performed with a morbidity and mortality similar to those of open surgery. In addition, it allows shorter hospital stays and convalescence (2,3). Finally, it offers the advantage of allowing an inspection of the inner surface of cyst walls, and biopsies of any suspicious lesions.

References

1. Russell RT, Pinson CW. Surgical management of polycystic liver disease. World J Gastroenterol 2007; 13: 5052-9.        [ Links ]

2. Fabiani P, Iannelli A, Chevallier P, Benchimol D, Bourgeon A, Gugenheim J. Long-term outcome after laparoscopic fenestration of symptomatic simple cysts of the liver. Br J Surg 2005; 92: 596-7.        [ Links ]

3. Civello IM, Matera D, Maria G, Nigro C, Brandara F, Brisinda G. Laparoscopic fenestration of symptomatic non-parasitic cysts of the liver. Hepatogastroenterology 2005; 52: 849-51.        [ Links ]