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Abstract: This patient is a 47-year-old middle-aged female with intermittent epigastric distension and pain without obvious reasons, the pain is not severe and tolerable, and sometimes accompanied by fever. When she went to the hospital for examination, she found a mass on her liver, and the patient was worried that it was cancer or would become cancerous in the future, and she was under great psychological pressure. After surgery, the patient’s symptoms were relieved and her recovery was smooth.
Basic information】Female, 47 years old
Type of disease】Hepatic cyst
Hospital】Hunan Provincial People’s Hospital
Date of consultation】May 2022
Treatment plan】Surgical treatment (hepatic cyst removal surgery) + intravenous infusion (ceftazidime for injection)
Treatment Period】9 days in hospital
Effectiveness】Significant relief of discomfort and basic recovery
I. Initial consultation
The patient, female, 47 years old, reported that she started to have epigastric distension and pain 1 month ago without any obvious reason, feeling no obvious connection with eating, the pain was not severe and could be tolerated, sometimes accompanied by fever, the temperature could reach up to 39℃, at first the patient thought it was a cold and did not pay attention to it, then the symptoms appeared several times, and she went to the hospital for examination and found that a mass had grown on her liver. After CT examination, a well-defined mass on the liver with a size of about 106×74mm was found, and there was a separation inside the mass, so liver cyst or cystic adenoma was considered as a possibility. After fully communicating with the patient and family about the current diagnostic considerations and the developed treatment plan, the patient and family agreed and the patient was admitted to our hospital.
II. Treatment process
After admission, relevant examinations were completed and the patient’s cardiopulmonary function was evaluated. The patient was first given ceftazidime for injection for anti-infection treatment, and after adequate preoperative preparation, combined with the preoperative CT examination results, the patient was considered to have a hepatic cyst with intracapsular infection, and cystadenoma could not be completely excluded. Together with the assessment of the patient’s liver function, the patient’s liver function was basically normal and could tolerate partial hepatectomy, and it was decided to perform partial hepatectomy. Before the operation, we fully communicated with the patient and his family to reduce the patient’s psychological pressure, informed the patient of the current necessity of surgical treatment for liver cysts, and also informed the patient that liver cysts are relatively common benign occupying lesions in the liver and will not become malignant, and the patient and his family agreed to the treatment opinion after full consideration. Minimally invasive surgery was performed for the patient, and the laparoscopic technique was used to completely remove the liver with the mass, and the operation was very smooth with minimal bleeding and no complications such as bile leakage.
III. Treatment results
The patient recovered quickly after surgery, and following the concept of rapid recovery, the patient was allowed to start drinking water on day 1, and started to get out of bed on day 2. It was confirmed that there was no postoperative bile leakage, and the abdominal drain was removed as soon as possible. On the 6th postoperative day, the patient’s routine blood and liver function tests were basically normal, and the rest of the abdominal cavity was free of fluid except for a small amount of fluid in the operative area on re-examination of CT.
IV. Notes
I am pleased that the patient’s condition has improved, but I also need to advise the patient to pay attention to after discharge.
1. start daily diet with a liquid diet as far as possible and gradually transition to a normal diet to avoid causing symptoms such as digestive discomfort.
2. Try to carry out rehabilitation activities as early as possible after surgery, which will help to promote incision healing, accelerate the recovery of gastrointestinal function, reduce the occurrence of infection and avoid the formation of venous thrombosis.
3. Pay attention to regular review to observe whether there is any recurrence of liver cysts. Patients are recommended to have regular imaging examination within six months to one year after surgery, and if there is no recurrence, they can have regular physical examination every year after surgery.
V. Personal insight
Liver cysts are relatively common benign masses in the liver, if the cysts are small, most patients will not have obvious symptoms, but when the cysts are large, some patients may have abdominal distension, like the case of the patient in this case is accompanied by abdominal discomfort, the cysts are large and may compress the stomach, resulting in abdominal distension after eating a small amount of food, and even nausea, vomiting and other manifestations, and some cysts are combined with infection. Patients may have chills, fever, abdominal pain and other symptoms of infection. Commonly used surgical methods are opening and excision, and cyst excision can completely eliminate the risk of recurrence.