# Spontaneous rupture and hemorrhage of a large simple hepatic cyst following external electrical muscle stimulation: a case managed by emergency laparoscopy

## TL;DR

A woman's large liver cyst ruptured after electrical muscle stimulation, and was successfully treated with laparoscopic surgery.

## Contribution

This case suggests that EMS may trigger rupture of large liver cysts, especially in patients with mild thrombocytopenia.

## Key findings

- A 10-cm ruptured hepatic cyst was found after EMS treatment in a patient with mild thrombocytopenia.
- Emergency laparoscopic cyst deroofing and sclerotherapy successfully managed the rupture without blood transfusion.
- Histopathology confirmed a simple biliary cyst with no recurrence at 6-month follow-up.

## Abstract

Hemorrhagic rupture of a simple liver cyst is a rare clinical occurrence. Whether external physical forces can trigger such rupture remains unclear. A 47-year-old woman presented with acute abdominal pain 72 h following an electrical muscle stimulation (EMS) session for weight reduction. Cross-sectional imaging demonstrated a 10-cm ruptured cyst in the right hepatic lobe with associated 1.5 l of hemoperitoneum. Her platelet count was 88 × 109/l. The patient successfully underwent emergency laparoscopic cyst deroofing with povidone-iodine sclerotherapy and did not require blood transfusion. Histopathology confirmed a simple biliary cyst, and a follow-up magnetic resonance imaging at 6 months showed no recurrence. This case suggests that vigorous muscular contractions from EMS may act as a potential precipitating factor for the rupture of large liver cysts, particularly in the context of mild thrombocytopenia, while spontaneous rupture cannot be entirely excluded as an alternative etiology. Laparoscopic management with chemical ablation represents an effective emergency treatment strategy.