Complications arising in simple and polycystic liver cysts

Abstract

Liver cysts are common, affecting 5%-10% of the population. Most are asymptomatic, however 5% of patients develop symptoms, sometimes due to complications and will require intervention. There is no consensus on their management because complications are so uncommon. The aim of this study was to perform a collected review of how a series of complications were managed at our institutions. Six different patients presenting with rare complications of liver cysts were obtained from Hepatobiliary Units in the United Kingdom and The Netherlands. History and radiological imaging were obtained from case notes and computerised radiology. As a result, 1 patient admitted with inferior vena cava obstruction was managed by cyst aspiration and lanreotide; 1 patient with common bile duct obstruction was first managed by endoscopic retrograde cholangiopancreatography and stenting, followed by open fenestration; 1 patient with ruptured cysts and significant medical co-morbidities was managed by percutaneous drainage; 1 patient with portal vein occlusion and varices was managed by open liver resection; 1 patient with infected cysts was treated with intravenous antibiotics and is awaiting liver transplantation. The final patient with a simple liver cyst mimicking a hydatid was managed by open liver resection. In conclusion, complications of cystic liver disease are rare, and we have demonstrated in this series that both operative and non-operative strategies have defined roles in management. The mainstays of treatment are either aspiration/sclerotherapy or, alternatively laparoscopic fenestration. Medical management with somatostatin analogues is a potentially new and exciting treatment option but requires further study.

Keywords: Complications; Cysts; Liver; Polycystic.

Figure 1

Computed tomography. A: The liver cyst causing common bile duct compression and dilation of the intrahepatic bile ducts; B: Multiple liver cysts with free fluid around the liver; C: The cyst compressing the portal vein; D: The splenic varices from the resulting portal hypertension.

Figure 2

A cross-sectional magnetic resonance imaging scan confirming the homogenous appearance of the cysts suggestive of a simple liver cyst.

Figure 3

Coronal magnetic resonance image showing the liver lesion with apparent internal membranes extending from segments V and VI of the liver to the right iliac fossa.

Figure 4

The resected liver cyst of patient 3 with attached small bowel.

Figure 5

A transverse section of the abdomen on computed tomography scanning. The left 4 panels represent cranio-caudal sections of the abdomen while the right 4 panels represent magnifications. Panel 4 shows the normal inferior vena cava (CV) and aorta (A), but the CV becomes compressed as can be seen in panel 1-3.

Figure 6

A positron emission tomography-computed tomography scan during the infection (A) and after treatment (B). Picture A shows appearances consistent with multiple infectious cysts, with a medium intense, circular fluorodeoxyglucose-accumulation in the middle of the right liver.