Giant infected hepatic cyst causing exclusion pancreatitis: A case report

Abstract

BACKGROUND

An infected hepatic cyst causes clinical symptoms, such as fever and abdominal pain. A cyst with a diameter > 10 cm increases the likelihood of exclusion symptoms in adjacent organs. Herein, we report a case of pancreatitis caused by an infected hepatic cyst.

CASE SUMMARY

The patient was an 88-year-old woman with a history of polycystic liver disease and a cyst > 10 cm in diameter. She was referred to our hospital for upper abdominal pain that persisted for four days before consultation. She had a fever of 37.4ºC, and a blood test showed a C-reactive protein level of 23 mg/dL. An infected hepatic cyst was diagnosed by abdominal ultrasonography, computed tomography, and magnetic resonance imaging. Antibacterial therapy and percutaneous cyst puncture did not elicit sufficient therapeutic effects. As the cyst growth continued, laparoscopic hepatic cyst fenestration was performed on hospitalization day 20. Thereafter, symptoms improved, and she was discharged on hospital day 31.

CONCLUSION

To our knowledge, this is the second case report of pancreatitis associated with hepatic cyst growth. Percutaneous cyst puncture and drainage or surgical therapy can be considered if a slight improvement with antibiotic therapy alone or exclusion of surrounding organs is observed. Further, attention is needed to avoid potential recurrence.

Keywords: Infected hepatic cyst; Giant hepatic cyst; Klebsiella; Pancreatitis; Case report

Core Tip: A giant infected hepatic cyst may cause exclusion pancreatitis. Thus, attention should be paid to the appearance of symptoms and elevation in the levels of pancreatic enzymes. In case of a slight improvement in clinical symptoms and imaging findings with antibiotic therapy alone or exclusion of surrounding organs, percutaneous cyst puncture and drainage or surgical therapy can be considered. Further, close follow-up is needed to avoid potential recurrence.