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Intraoperative air leak test was useful for the detection of a small biliary fistula: A rare case of non-parasitic hepatic cysts with biliary communication

INTRODUCTION: Symptomatic non-parasitic hepatic cysts with biliary communication are rare and no standard treatment has been established yet. Careful attention should be paid to avoidance of postoperative bile leakage during surgical treatment. PRESENTATION OF CASE: We report the case of a 74-year-o...

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Autores principales: Shimizu, Atsushi, Hata, Shojiro, Kobayashi, Kaoru, Teruya, Masanori, Kaminishi, Michio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4643437/
https://www.ncbi.nlm.nih.gov/pubmed/26398333
http://dx.doi.org/10.1016/j.ijscr.2015.09.014
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author Shimizu, Atsushi
Hata, Shojiro
Kobayashi, Kaoru
Teruya, Masanori
Kaminishi, Michio
author_facet Shimizu, Atsushi
Hata, Shojiro
Kobayashi, Kaoru
Teruya, Masanori
Kaminishi, Michio
author_sort Shimizu, Atsushi
collection PubMed
description INTRODUCTION: Symptomatic non-parasitic hepatic cysts with biliary communication are rare and no standard treatment has been established yet. Careful attention should be paid to avoidance of postoperative bile leakage during surgical treatment. PRESENTATION OF CASE: We report the case of a 74-year-old man who visited our department complaining of right upper abdominal pain and elevated serum levels of the liver enzymes. Computed tomography revealed hepatic cysts including a large one measuring 16 cm in diameter in Segments IV and VIII. Percutaneous drainage of the cyst revealed bile-staining of the cyst fluid. Endoscopic retrograde cholangiography demonstrated the presence of a cyst–biliary communication. We performed open deroofing of the cyst. During the operation, the biliary fistula was invisible, however, air injection into the bile duct through the stump of the cystic duct caused release of air bubbles from the cyst cavity, which allowed us to detect the small biliary orifice and repair it successfully by suture. DISCUSSION: We utilized the intraoperative air leak test, which has previously been reported to be effective for preventing postoperative bile leakage in patients undergoing hepatectomy to detect of a small cyst–biliary communication in a case undergoing non-parasitic hepatic cyst surgery. CONCLUSION: An intraoperative air leak test may be a useful test during surgical treatment of non-parasitic hepatic cysts with biliary communication.
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spelling pubmed-46434372015-12-08 Intraoperative air leak test was useful for the detection of a small biliary fistula: A rare case of non-parasitic hepatic cysts with biliary communication Shimizu, Atsushi Hata, Shojiro Kobayashi, Kaoru Teruya, Masanori Kaminishi, Michio Int J Surg Case Rep Case Report INTRODUCTION: Symptomatic non-parasitic hepatic cysts with biliary communication are rare and no standard treatment has been established yet. Careful attention should be paid to avoidance of postoperative bile leakage during surgical treatment. PRESENTATION OF CASE: We report the case of a 74-year-old man who visited our department complaining of right upper abdominal pain and elevated serum levels of the liver enzymes. Computed tomography revealed hepatic cysts including a large one measuring 16 cm in diameter in Segments IV and VIII. Percutaneous drainage of the cyst revealed bile-staining of the cyst fluid. Endoscopic retrograde cholangiography demonstrated the presence of a cyst–biliary communication. We performed open deroofing of the cyst. During the operation, the biliary fistula was invisible, however, air injection into the bile duct through the stump of the cystic duct caused release of air bubbles from the cyst cavity, which allowed us to detect the small biliary orifice and repair it successfully by suture. DISCUSSION: We utilized the intraoperative air leak test, which has previously been reported to be effective for preventing postoperative bile leakage in patients undergoing hepatectomy to detect of a small cyst–biliary communication in a case undergoing non-parasitic hepatic cyst surgery. CONCLUSION: An intraoperative air leak test may be a useful test during surgical treatment of non-parasitic hepatic cysts with biliary communication. Elsevier 2015-09-16 /pmc/articles/PMC4643437/ /pubmed/26398333 http://dx.doi.org/10.1016/j.ijscr.2015.09.014 Text en © 2015 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Shimizu, Atsushi
Hata, Shojiro
Kobayashi, Kaoru
Teruya, Masanori
Kaminishi, Michio
Intraoperative air leak test was useful for the detection of a small biliary fistula: A rare case of non-parasitic hepatic cysts with biliary communication
title Intraoperative air leak test was useful for the detection of a small biliary fistula: A rare case of non-parasitic hepatic cysts with biliary communication
title_full Intraoperative air leak test was useful for the detection of a small biliary fistula: A rare case of non-parasitic hepatic cysts with biliary communication
title_fullStr Intraoperative air leak test was useful for the detection of a small biliary fistula: A rare case of non-parasitic hepatic cysts with biliary communication
title_full_unstemmed Intraoperative air leak test was useful for the detection of a small biliary fistula: A rare case of non-parasitic hepatic cysts with biliary communication
title_short Intraoperative air leak test was useful for the detection of a small biliary fistula: A rare case of non-parasitic hepatic cysts with biliary communication
title_sort intraoperative air leak test was useful for the detection of a small biliary fistula: a rare case of non-parasitic hepatic cysts with biliary communication
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4643437/
https://www.ncbi.nlm.nih.gov/pubmed/26398333
http://dx.doi.org/10.1016/j.ijscr.2015.09.014
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