A Case of Emergency Surgery for Hemorrhagic Rupture of a Liver Cyst in a 91-Year-Old Woman

Abstract

There are few reports of hemorrhagic rupture of liver cysts. Here, we report a case of emergency surgery for hemorrhagic shock due to a ruptured hepatic cyst in a 91-year-old woman. The patient was treated under a diagnosis of pyelonephritis and septic shock at another hospital. She had acute lower right abdominal pain and her vital signs were in pre-shock, and she was transferred to our hospital. Contrast-enhanced CT showed a cystic lesion in the posterior segment of the liver and ascites with a high CT value around the liver. She was diagnosed with hemorrhagic shock due to hemorrhagic rupture of a liver cyst. The CT examination revealed no extravasation. Thus, transcatheter hemostasis was thought to be inapplicable, and emergency surgery for hemostasis was selected. The right lobe of the liver was mobilized under the Pringle maneuver to expose the wall of the hepatic cyst. Bleeding from the ruptured hepatic cyst was confirmed and hemorrhagic rupture of the liver cyst was diagnosed intraoperatively. The cyst wall was excised to identify and suture the bleeding site in the Glissonean sheath. The ascites in the Douglas fossa was infectious. We concluded that hepatic cyst bleeding triggered by hepatic cyst infection and subsequent cyst rupture led to hemorrhagic shock with acute abdominal pain. Despite her advanced age of 91 years old, the patient was discharged after 14 days without surgical complications.