Infected hepatic cyst following pancreatoduodenectomy treated with transhepatic drainage and minocycline hydrochloride injection: A case report

INTRODUCTION: Asymptomatic hepatic cysts, often observed on computed tomography, have never been reported as a risk factor for infection following pancreatoduodenectomy. Symptomatic liver cysts are treated surgically or non-surgically. We encountered a case of infected hepatic cyst following pancreatoduodenectomy. PRESENTATION OF CASE: An 88-year-old woman underwent pancreatoduodenectomy for adenocarcinoma in the duodenum papilla of Vater. She was discharged (postoperative day 23), following an uneventful course. However, 7 days later, she was re-admitted because of a high fever; postoperative cholangitis was suspected. A peripheral-venous blood bacterial culture was negative. Her C-reactive protein level and white blood cell count were 0.57 mg/dl and 5290/μl, respectively. Antibiotics were administered, but her high fever only temporarily decreased. Contrast-enhanced computed tomography showed ring enhancement surrounding the largest of several hepatic cysts. Percutaneous transhepatic drainage was performed; thereafter, minocycline hydrochloride was repeatedly injected into the infected cyst through the drain to prevent infection recurrence. The drain was removed 49 days after drainage. On contrast-enhanced computed tomography at 6 months postoperatively, the infected hepatic cyst had reduced in size from 6.0 to 1.7 cm and no findings of bile duct stenosis were observed. No further infectious events have been observed. DISCUSSION: Relatively large hepatic cysts may be at risk of infection following pancreatoduodenectomy and, in particular, biliary reconstruction. CONCLUSION: Transhepatic drainage, rather than antibiotic administration, is essential, and minocycline hydrochloride injection into infected cyst that have no evidence of communication with the biliary tree is effective in preventing infection recurrence, without the complication of bile duct stenosis.