Cystic Disease of the Liver

The clinical presentation, pathology, and appropriate surgical management of cysts of the liver were analyzed in a review of 150 cases of hepatic cystic disease encountered surgically at the Mayo Clinic from Jan. 1, 1954, through Dec. 31, 1971. The incidence of this disease was 17 per 10,000 abdominal explorations. The series included 82 solitary cysts, of which 15 produced symptoms; 49 multiple cysts, of which 7 were symptomatic; 13 hydatid cysts, of which 12 were symptomatic; 3 traumatic cysts, of which 2 were symptomatic; and 3 inflammatory cysts, of which 1 was symptomatic. Symptoms, when present, comprised (in order of frequency) the presence of an abdominal mass, abdominal pain, and hepatomegaly. Congenital and hydatid cysts were located most often in the right lobe of the liver. The smallest cysts were the multiple cysts (average diameter, 4.3 cm) and the largest were the hydatid cysts (average diameter, 10.5 cm). Histologically, the lining of the congenital cysts most often was of cuboidal epithelium. The treatment of congenital cysts included simple biopsy, aspiration, and excision. In cases of hydatid cysts, preliminary sterilization was found to be essential prior to aspiration. Hydatid cysts may be excised or opened, evacuated, and the cavity obliterated. In certain cases hepatic resection may be warranted in order to remove all of the hydatid disease.