A Case of an Infected Liver Cyst following Cholecystectomy with Drainage for Gallbladder Perforation and Panperitonitis

Abstract

An 88-year-old woman presented to our hospital because of abdominal pain and underwent emergency operation with a diagnosis of septic shock due to panperitonitis. Perforation of the gallbladder was diagnosed based on intraoperative findings, and cholecystectomy and abdominal drainage were performed. A cyst which was confirmed to be at the porta hepatis of the right lobe of liver by preoperative CT scan gradually enlarged after the operation. The cyst was accompanied by dilatation of the peripheral bile duct, but she was asymptomatic. We had followed his clinical course until 61^st postoperative day, when he suddenly developed high fever with chill and trepidation. We diagnosed the case as cholangitis and infected hepatic cyst from CT findings, and on the same day, performed ultrasonic-guided percutaneous transhepatic abscess drainage. Since white purulent discharge amounted to 35 ml and E. coli was isolated from cultures of the blood and content fluid of the cyst, the cyst was determined to be the source of infection. Administration of antibiotics and drainage resulted in symptomatic remission, so that the drain was removed on the 38^th day after initiation of the drainage. Thereafter no further enlargement of the cyst has occurred. Hepatic cysts follow an asymptomatic course in most cases, however, if the cyst tends to enlarge, we must keep a possibility of causing infectious hepatic cyst in mind.