A Case of a Spontaneously Ruptured Giant Hepatic Cyst with Biliary Communication Successfully Treated with Laparoscopic Deroofing Using Intraoperative Indocyanine Green Fluorescent Cholangiography

Abstract

Recently, indocyanine green fluorescent cholangiography has been reported to effectively delineate the biliary tree during surgery. A case of a spontaneously ruptured giant hepatic cyst with biliary communication successfully treated with laparoscopic deroofing using intraoperative indocyanine green fluorescent cholangiography is presented.

An 89-year-old woman was admitted to our hospital due to right hypochondralgia of sudden onset with no history of abdominal trauma. Abdominal CT showed a giant hepatic cyst with a diameter of 15 cm located in the right hepatic lobe and fluid collection. Drip infusion CT cholangiography showed contrast medium pooling in the hepatic cyst. Therefore, biliary peritonitis caused by a spontaneously ruptured hepatic cyst communicating with a bile duct was diagnosed, and laparoscopic deroofing was emergently performed under the guidance of intraoperative indocyanine green fluorescent cholangiography. The bile leakage was detected at the bottom of the hepatic cyst using intraoperative indocyanine green fluorescent cholangiography, and it was closed with laparoscopic suturing technique. There was no postoperative bile leakage, the patient's postoperative course was uneventful, and she was discharged from the hospital.