Laparoscopic deroofing to treat an infected hepatic cyst because of fistula formation between the hepatic cyst and the duodenum ulcer

TL;DR

A 71-year-old woman with an infected liver cyst and a fistula to the duodenum was successfully treated with laparoscopic surgery.

Contribution

This case highlights laparoscopic deroofing as an effective treatment for infected non-parasitic hepatic cysts with fistulas.

Findings

Laparoscopic deroofing resolved chronic inflammation after initial antibiotic and drainage treatments failed.

No recurrence was observed 6 months post-surgery.

Surgical intervention should be considered alongside conservative treatments for such infections.

Abstract

We describe a rare case of laparoscopic deroofing to treat an infected hepatic cyst because of fistula formation between the hepatic cyst and the duodenum ulcer. A 71-year-old female was referred to our hospital for the evaluation of her abdominal pain. The laboratory workup revealed a high inflammatory reaction. Computed tomography (CT) visualized a large hepatic cyst in the left hepatic lobe, causing suspicion of a fistulous tract between the hepatic cyst and duodenum. A hepatic cyst infection was diagnosed, and both antibiotic treatment and percutaneous cyst drainage were performed. Although the acute inflammation improved after these treatments, chronic inflammation continued. We conducted laparoscopic deroofing of the infected cyst. The patient’s post-operative course was uneventful, and CT revealed no recurrence 6 months post-procedure. For patients with non-parasitic hepatic cyst infection, physicians should consider not only conservative antibiotic treatment but also surgical treatment including laparoscopic cyst deroofing.

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