2018 Volume 60 Issue 4 Pages 997-1002
A 79-year-old woman who suffered from anorexia, nausea, and discomfort in the upper abdomen, presented to our hospital. Abdominal computed tomographic (CT) scan and esophagogastroduodenoscopy revealed a large hepatic cyst with air fluid level and a fistula between the duodenal bulb and the hepatic cyst. The diagnosis of hepatoduodenal fistula was made. We first chose conservative management because there were no signs of acute panperitonitis. As the fistula decreased in size, it did not function as a drainage route from the hepatic cyst. The hepatic cyst became infected and required small incision laparotomy and placement of a drainage tube. As a result, the fistula closed spontaneously over time and the hepatic cyst shrunk. We could avoid emergent or elective laparotomy by performing non-invasive treatment. It may be critical to drain out food residue and intestinal fluid from a hepatic cyst by placing a drainage tube through the percutaneous transhepatic route in conservative management of a hepatoduodenal fistula.
