Muhammad Saleem, Umza Ather, Abid Hamid Sheikh, Mahmood Shaukat, Munawar Jamil, Javid Sadiq, Rehmat Ullah.
Congenital Solitary Biliary Cyst of Liver
J Coll Physicians Surg Pak Jan 2000;10(1):40-1.
Department of Paediatric Surgery, Quaid-i-Azam Medical College Bahawalpur

This is a case report of a 5-year-old girl, who presented with abdominal pain and a mass in the epigastrium. The ultrasound revealed a cystic mass in the epigastrium anterior to left lobe of liver and stomach. On exploration a large cyst was found in the left lobe of liver containing bilious fluid. Roux-en-Y cystojejunostomy was performed, Recovery was uneventful.

CASE REPORT: A 5-year-old girl presented with history of abdominal pain since two years, progressive weight loss for 1.5 years and a gradually increasing mass in the epigastrium for one year.The child developed fever and occasional vomiting over the last months. There was no history of jaundice, haematemesis,and respiratory problem. Clinical examination revealed a visible mass in the upper abdomen. It was about 10x10cms in size occupying epigastrium and adjacent left hypochondrium. Blood examination revealed haemoglobin 8.5 gm/dl and TLC 7100/mm3. Liver function tests were normal.Ultrasound scan revealed 9x7x6.8 cms echogenic cystic mass in the epigastrium anterior to the stomach with a lot of debris in it.According to one report it was not apparently related to the liver and pancreas.An upper barium series showed that the stomach was pushed to the left with a mass effect along the lesser curvature. Gastric emptying was normal.

At laparotomy, a large thick walled cyst was found occupying almost whole of the left hepatic lobe. Right lobe of the liver and biliary passage were normal. Aspiration of the cyst revealed bilious fluid indicating communication with the biliary tree. Complete excision was impossible due to enormous size. A retrocolic Roux-en-Y cystojejunostomy was performed.A part of the cyst wall was sent for histopathology.The cytology of aspirated fluid revealed few blood cells,acute and chronic inflammatory cells, and necrotic material containing many gram-negative bacilli and few gram-positive cocci. Bile pigments, sugar and protein were present in the fluid. Histopathology revealed that cyst was lined by cuboidal epithelium and composed mainly of fibrovascular tissue, infiltrated with acute and chronic inflammatory cells. The patient recovered smoothly, and was discharged after 10 days. The patient was symptom free at 1-1/2 year follow up with no resident cyst in liver on ultrasound.

Category: Case Reports
Keywords: Cysts. Solitary Cyst Liver. Congential Cysts. Liver.

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