Hemorrhagic hepatic cyst: report of a case and review of the literature with emphasis on clinical approach and management. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract OBJECTIVE:Hemorrhage within a hepatic cyst (hemorrhagic hepatic cyst, HHC) is a complication of liver cysts that is difficult to differentiate from other neoplastic entities on imaging. Even when accurately diagnosed, there has been a lack of consensus on the optimal treatment strategy. After presenting our experience with a patient treated via laparoscopy, we aimed to conduct a review of the literature on HHCs. METHODS:A computerized search in Medline, PubMed, Google Scholar, and The Cochrane Collaboration was carried out for journal articles or abstracts published from 1950 to 2011. RESULTS:A total of 24 patients with HHCs were identified from 1983 to 2011. The cohort had an even gender distribution with a mean age of 62.7 years. Most patients presented with abdominal pain (80 %), while three (14 %) patients were asymptomatic at the time of presentation. CT imaging and ultrasound were unable to accurately diagnose HHC, whereas hyperintensity on MRI was a reliable diagnostic tool. Three (13 %) patients were managed conservatively with observation. Seven (30 %) patients had percutaneous transhepatic drainage. Among these, two patients experienced recurrence that required repeat treatment. Two (9 %) patients underwent open unroofing of their HHC and one (4 %) laparoscopically, without recurrences. Seven (30 %) patients underwent hepatic resection, whereas six (26 %) patients had a cyst enucleation for their HHCs. All patients had uneventful recoveries, with a mean follow-up of 25 months. CONCLUSIONS:MRI is a reliable diagnostic tool in the setting of an HHC. Laparoscopic unroofing of HHCs may represent a less morbid and safe treatment modality with low recurrence rates. Given the low level of clinical evidence available so far, these results should be interpreted with caution. 10.1007/s11605-012-1922-6

Extraperitoneal hemorrhagic rupture of a simple hepatic cyst. A case report and literature review. Vannucchi Andrea,Masi Andrea,Vestrini Gabriele,Tonelli Francesco Annali italiani di chirurgia Hemorrhagic rupture is a very rare complication of a simple hepatic cyst. We report the first case of a totally extraperitoneal rupture of a recurrent cyst, occurred in a 73-year-old man who presented with acute right hypochondralgia. Computed tomography revealed the rupture of a large hemorrhagic cyst in the right liver lobe and the formation of a voluminous hematoma in the retroperitoneal space. Despite the absence of hemoperitoneum, the entity of the bleeding led us to perform an urgent and successful surgical intervention. A review of the literature was conducted. To date, 9 cases of hemorrhagic rupture of simple hepatic cyst have been described and our case is the first one characterized by extraperitoneal bleeding. Our clinical management was in accordance with the majority of the other Authors. Different surgical procedures have been proposed and the best approach has not been established yet. However, the laparotomic approach should be preferred for a better control of the bleeding. In conclusion, the hemorrhagic rupture of a liver cyst is a life-threatening complication and a prompt surgery is necessary to prevent the hypovolemic shock. KEY WORDS:Extraperitoneal rupture, Hemorrhagic rupture, Simple hepatic cyst.

[A Resected Case of Hemorrhagic Hepatic Cyst Difficult to Differentiate from Mucinous Cystic Neoplasm of the Liver]. Park Sung Ae,Tomimaru Yoshito,Noguchi Kozo,Nagase Hirotsugu,Ogino Takayuki,Hirota Masashi,Oshima Kazuteru,Tanida Tsukasa,Noura Shingo,Kawase Tomono,Imamura Hiroshi,Akagi Kenzo,Iwazawa Takashi,Dono Keizo Gan to kagaku ryoho. Cancer & chemotherapy CASE:A 77-year-old woman was referred to our hospital for detailed examination of a cystic liver tumor. Contrast-enhanced CT and MRIshowed a cystic liver tumor with an enhanced mural nodule in S6 of the liver. Under a preoperative diagnosis of hemorrhagic hepatic cyst and mucinous cystic neoplasm(MCN)of the liver, extended posterior segmentectomy was performed. Histological examination of the tumor revealed no neoplastic cells, and the tumor was finally diagnosed as a hemorrhagic hepatic cyst of the liver. CONCLUSION:Similar to previous reports of hemorrhagic hepatic cysts, preoperative differential diagnosis from MCN of the liver was difficult in this case. Hemorrhagic hepatic cysts are rare and are sometimes confused with MCN of the liver, especially when an enhanced mural nodule is found in the cyst. The possibility of hemorrhagic hepatic cysts should be considered during diagnosis of liver cystic tumors.

Hemorrhagic liver cyst rupture: an unusual life-threatening complication of hepatic cyst and literature review. Marion Yoann,Brevartt Christophe,Plard Laurent,Chiche Laurence Annals of hepatology BACKGROUND & AIMS:Hemorrhagic rupture is an extremely rare complication of hepatic cyst. Its incidence, gravity and treatment modalities are inadequately covered in the literature. Material and methods. Based on a case report concerning a 37 year-old, 13-weeks pregnant woman, presenting with hemorrhagic shock subsequent to hemorrhagic rupture of a hepatic cyst and requiring urgent surgery, a review of the literature was conducted. RESULTS:To date, 11 cases have been described in the literature. This complication is particularly serious with six cases of hemorrhagic shock, three of which led to death. In the majority of cases, urgent surgical treatment is required. CONCLUSIONS:Hepatic cysts are frequent benign tumors of the liver which are most often discovered fortuitously. Hemorrhagic rupture is the rarest associated complication, yet requires to be known for it is both serious and lethal and necessitates urgent surgical intervention.