Delayed Intracystic Bleeding Leading to Hemorrhagic Shock after Hepatic Cyst Fenestration

Abstract

A 70-year-old woman had undergone laparoscopic liver cyst fenestration for a simple cyst in the right lobe of the liver. Seven months postoperatively, she developed bleeding from the hepatic cyst and was transferred to our hospital. The cyst was growing, and angiography showed contrast agent extravasation into the cyst from the peripheral side of the posterior segmental branch of the right hepatic artery. Preoperative computed tomography also showed signs of bleeding in the S8 hepatic dome and beneath the diaphragm, and embolization of the right hepatic artery peripheral to the cystic artery, A4, and the right subphrenic artery was conducted to embolize the arteries feeding the hepatic cyst as a whole. Seven hours later, the patient's blood pressure dropped rapidly, and it was considered that the embolization had been insufficient. Angiography was again performed, and coil embolization of the right hepatic artery was conducted, including the part as far as the cystic artery, after which hepatic cystectomy and cyst fenestration were performed. However, since recurrent cyst growth and progressive anemia were then observed, radical cystectomy was eventually performed. The patient is currently being monitored as an outpatient, and as of one year after the cystectomy, there has been no sign of recurrence. A rare case of a patient who developed delayed intracystic bleeding with hemorrhagic shock after hepatic cyst fenestration is reported.