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. 2022 May 6;8(1):87.
doi: 10.1186/s40792-022-01445-2.

Laparoscopic complete excision of an enormous simple hepatic cyst occupying the entire abdomen in a child: a case report and literature review

Nozomi Matsushita  1 , Kenitiro Kaneko  2 , Shoko Kato  1 , Takayuki Odashima  1 , Remi Kondo  1 , Takahiro Fukuyama  1 , Takuya Saito  1 , Yasuyuki Fukami  1 , Shunichiro Komatsu  1 , Tsuyoshi Sano  1
Affiliations

Laparoscopic complete excision of an enormous simple hepatic cyst occupying the entire abdomen in a child: a case report and literature review

Nozomi Matsushita et al. Surg Case Rep. .

Abstract

Background: Simple hepatic cysts are common lesions in adults, but rare in children. Because of their benign nature, simple hepatic cysts may not be detected until they grow too large to be diagnosed and resected in a minimally invasive manner.

Case presentation: An 18-month-old girl presented with an enormous cyst occupying the entire abdomen. The beak sign on computed tomography revealed the hepatic origin of the cyst. The cyst was decompressed through the umbilicus, which was opened by the three-triangular-skin-flap technique, thus creating a working space that enabled laparoscopic surgery. The cyst was excised en bloc together with the attached hepatic parenchyma.

Conclusions: Giant simple hepatic cysts occupying the entire abdomen are rare in children. Of 14 reported cases, only 1 underwent laparoscopic treatment. We have herein reported another case of a giant simple hepatic cyst in which the beak sign on imaging and the three-triangular-skin-flap umbilical opening technique were useful for its diagnosis and laparoscopic excision, respectively. Complete excision is desirable because there is a possibility of recurrence or other diseases that require total removal, including hydatid cysts and mesenchymal hamartomas.

Keywords: Children; Enormous abdominal cyst; Laparoscopic excision; Simple hepatic cysts.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Dynamic computed tomography image of a huge abdominal cyst. The wall was thin, smooth, and not enhanced by contrast agent. The beak sign was evident, indicating a hepatic origin (arrows)
Fig. 2
Fig. 2
Umbilical opening technique and aspiration. The umbilicus was opened widely using the three-triangular-skin-flap technique, which created adequate exposure of the cyst wall for aspiration without spillage
Fig. 3
Fig. 3
Operative findings. After decompression, laparoscopy revealed that the cyst originated from the inferior surface of liver segments 5 and 6
Fig. 4
Fig. 4
Post-excision view. The cyst with attached hepatic parenchyma was completely removed. The resected surface was covered with a tissue-sealing sheet (TachoSil; CSL Behring KK, Tokyo, Japan)
Fig. 5
Fig. 5
Ultrasonography 1 year after the operation showed a good portal flow at the posterior branch and no liver atrophy
Fig. 6
Fig. 6
Pathological findings. A Most of the cyst wall was lined by a simple flattened epithelium; a few parts were lined by a B stratified squamous epithelium and C cuboidal epithelium. D Small bile duct-like structures (arrowheads) were positive for cytokeratin 7, as were the cyst epithelia, suggesting an aberrant bile duct origin of the cyst and squamous metaplasia
See this image and copyright information in PMC

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