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Objective: The relevance of nonparasitic cysts of the liver (NPCL) is related to their steadily increasing incidence, high recurrence rates, delayed diagnosis, and potential complications. In general, hepatic cysts (HCs) are classified into several types, including simple and complex, false and true. Simple cysts are mainly congenital but also occur in polycystic liver disease. Complex cysts include mucinous neoplasms, echinococcal cysts, hemorrhagic cysts, cystic hepatocellular carcinoma, and other rare lesions. Nonparasitic cystic liver lesions do not usually cause symptoms, and their characteristics are not specific. In 15% of cases, nonspecific signs (flatulence, nausea, dyspepsia) accompany pain. Diagnosis of NPCL is based on data from ultrasound, CT, or MRI of the abdominal organs. There still needs to be a consensus on surgical treatment indications or the effectiveness and feasibility of its various methods. Many surgical interventions for NPCL treatment include puncture drainage, multiple minimally invasive (laparoscopic) surgery options, and open methods. In clinical practice, laparoscopic fenestration, associated with fewer complications and faster recovery, has become widespread. However, significant progress has yet to be achieved in reducing NPCL recurrence rates despite advances in surgical treatment. Therefore, multiple studies are underway to improve treatment options for this medical condition.

We describe the spontaneous rupture of a simple hepatic cyst. A 62-year-old woman was admitted for right upper quadrant pain of sudden onset. The patient denied a history of abdominal trauma. Computed tomography of the abdomen showed a 13-cm-diameter solitary hepatic cyst in the right lobe. Part of the cyst surface was irregular, and the internal echo was heterogeneous. Retained fluid was detected under the liver capsule. Ten days after admission, computed tomography revealed that the volume of fluid retained under the liver capsule had decreased but that the hepatic cyst had enlarged again. The patient was referred to our hospital for further evaluation and treatment. Physical examination revealed mild right upper quadrant pain, but no signs or symptoms of peritonitis or abnormalities of the chest or heart. Percutaneous puncture was performed with a needle and an 8-French pigtail catheter under ultrasonographic guidance. Brown serous fluid was aspirated. After the removal of approximately 1,000 mL of fluid, contrast medium was injected to check for communications between the cyst and the biliary tree and to document the absence of leakage into the peritoneal cavity. After complete aspiration of the cyst fluid, 200 mg of minocycline hydrochloride dissolved in 10 mL of saline was injected into the cyst, and the catheter was flushed with 10 mL of saline (total volume of saline, 20 mL). The catheter was then clamped for 30 minutes. After percutaneous aspiration, the patient's symptoms resolved. Minocycline hydrochloride was injected daily for 7 days, and the catheter was removed. There has been no evidence of recurrence after 2 years. [ABSTRACT FROM AUTHOR]

We describe the spontaneous rupture of a simple hepatic cyst associated with a benign course. A 64-year-old woman was admitted for right upper quadrant pain. The patient denied a history of abdominal trauma. Abdominal computed tomography (CT) showed a huge solitary hepatic cyst (diameter, 10 cm) in the right lobe. Part of the cyst surface was irregular, and the interior was heterogeneous on ultrasonography. Fluid retention was detected under the liver capsule. Spontaneous rupture of a nonparasitic hepatic cyst was suspected. The patient was admitted to our hospital for further evaluation and treatment. Examination of the abdomen revealed right upper quadrant pain but no signs or symptoms of peritonitis. One week after admission, CT revealed that the volume of fluid retained under the liver capsule had decreased. Percutaneous puncture was performed with a needle and an 8-French pigtail catheter under ultrasonographic guidance. Serous, brown fluid was aspirated. After percutaneous aspiration, the patient's symptoms resolved. Minocycline hydrochloride was given daily by intravenous injection for 7 days. The catheter was then removed. There has been no evidence of recurrence after 1 year. [ABSTRACT FROM AUTHOR]

Fifteen patients with nonparasitic hepatic cysts underwent surgery to relieve abdominal complaints, at the First Surgical Department, Tokyo University Hospital between 1966 and 1989. Total removal of the cyst was carried out in 14 of the patients, while puncture and aspiration only were performed in the other patient in whom a cyst had ruptured spontaneously, after which hemoperitoneum was observed at emergency laparotomy. The size of the cysts varied from 7-19 cm with a mean of 12.4 cm. Histological study revealed a congenital cyst in 14 patients and a cystadenoma in one. The epithelium lining of the internal surface of the congenital cysts was highly atrophic and desolated and often disappeared. Examination of the cyst fluid revealed the same concentration of electrolytes as in the serum. Hepatic enzyme levels were usually lower than in the serum, but lactic dehydrogenase and aminotransferase levels were elevated in a few cases. Tumor marker levels of the cyst fluid were higher than those in the serum in four of five patients examined. [ABSTRACT FROM AUTHOR]

Giant solitary nonparasitic cysts of the liver are rarely encountered in children, and establishing a preoperative diagnosis is usually difficult, especially when the cyst occupies the entire abdomen. We report herein the case of an 8-year-old girl found to have a giant congenital solitary cyst of the liver masquerading as an ovarian cyst. [ABSTRACT FROM AUTHOR]