Frontiers in surgery
Spontaneous rupture and hemorrhage of a giant simple hepatic cyst in a 94-year-old woman: a case report
By Qiu J, Chen C and Li L.
Abstract
Background
Spontaneous rupture and hemorrhage of a simple hepatic cyst is a rare but potentially life-threatening complication, particularly in elderly patients. Because its clinical and imaging findings may mimic other complex cystic liver lesions, timely diagnosis and appropriate intervention are essential.
Case presentation
A 94-year-old woman presented with chronic upper abdominal pain that suddenly worsened. Computed tomography revealed a giant complex cystic lesion measuring approximately 20 cm in the left hepatic lobe, with internal high-density areas and thin septations. The differential diagnosis included a complicated hepatic cyst with intracystic hemorrhage and mucinous cystic neoplasm of the liver (MCN-L). The patient initially remained clinically stable; however, she subsequently developed worsening abdominal pain, chest tightness, shortness of breath, hypotension, tachycardia, and a decrease in hemoglobin from 85 g/L to 76 g/L. Contrast-enhanced computed tomography demonstrated massive intraperitoneal fluid consistent with hemoperitoneum. Emergency laparoscopic exploration revealed approximately 1,000 mL of intraperitoneal blood and a ruptured giant left hepatic cyst filled with blood clots. Laparoscopic left hepatectomy was performed. Postoperative pathology confirmed a simple hepatic cyst. The patient recovered uneventfully and was discharged on postoperative day 9.
