A Case of Laparoscopic Surgery for a Ruptured Infectious Liver Cyst Penetrated by a Stomach Ulcer in an Elderly Patient

Abstract

An 89-year-old woman came to our hospital with frequent abdominal pain and anorexia. The physical examination revealed rebound tenderness and muscle guarding on the epigastric and left hypochondrial regions. An abdominal computed tomography (CT) scan showed free air and a cystic lesion with an air-fluid content adjacent to the stomach. Upper gastrointestinal endoscopy revealed a perforated gastric ulcer at the lesser curvature of the gastric angle. The patient was diagnosed as having perforation of a gastric ulcer with an abdominal abscess and underwent emergency laparoscopic surgery. We found a collapsed liver cyst in the left hepatic lobe, and the perforation of the gastric ulcer into the liver cyst was revealed. The perforation of the gastric ulcer was covered with the greater omentum. We cut and excised the cyst wall under laparoscopy. The patient was discharged on the 25 postoperative day, without any deterioration in her activities of daily living (ADL). We report herein on a case of laparoscopic surgery in a very elderly patient with peritonitis due to a ruptured infectious liver cyst penetrated by a gastric ulcer.