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Abstract: A 64-year-old male with polycystic liver that had been found for decades without treatment came to our hospital for the past year or so because of significant abdominal distension and pain. Through examination, it was found that a part of the polycystic liver had a relatively large cyst growth. After communicating with the patient regarding his condition, the patient was given a laparoscopic partial hepatectomy to remove a part of the relatively large cyst. After the operation, the patient’s symptoms were significantly relieved and he was discharged successfully.
Basic information】Male, 64 years old
Disease Type】Polycystic liver
Hospital】Liaocheng People’s Hospital
Consultation time】November 2021
Treatment plan】Laparoscopic partial hepatectomy + laparoscopic decompression of liver cysts
Treatment Period】Inpatient treatment for 1 week, review after 6 months
Effectiveness of treatment] Disappearance of right upper abdominal distension and discomfort, delaying the progression of the disease
I. Initial consultation
The patient reported that polycystic liver had been found for decades, and initially there were no symptoms and no treatment, but only regular review. Later, he felt a mild feeling of fullness in the right upper abdomen, and after examination, he found that the number and size of cysts in polycystic liver were increasing, but he did not pay attention to it at that time and did not undergo any special treatment. However, in the past year, the feeling of distension and pain in the right upper abdomen continued to worsen, so he came to our hospital for consultation. After the outpatient clinic gave the patient an abdominal plain CT examination, the patient was found to have a polycystic liver with cysts mainly concentrated in the left liver. The patient was admitted to the hospital for further treatment.
After admission, the patient underwent liver function and kidney function tests, and the results indicated that the patient’s liver function and kidney function were within normal limits; subsequently, the patient underwent an intensive abdominal CT examination, and it was found that the patient’s polycystic liver was mainly concentrated in the left half of the liver, especially the relatively large fused cysts.
II. Treatment history
According to the patient’s condition, the treatment plan had 2 directions. The first one was to first remove part of the liver by minimally invasive laparoscopic surgery to remove some of the larger cysts to reduce and delay the progression of the disease. The 2nd treatment option is liver transplantation, which can be an option if a radical cure is desired. After explaining the condition and treatment plan with the patient’s family, the patient’s family requested to perform laparoscopic minimally invasive surgery first to remove as much of the patient’s cyst as possible while preserving the normal liver, so the patient underwent laparoscopic partial hepatectomy + laparoscopic decompression of liver cysts under general anesthesia.
III. Treatment results
Since the patient’s surgery was a minimally invasive laparoscopic surgery, the surgical trauma was very small and therefore the recovery was quick. The patient got out of bed on the first day after surgery, defecated and started to eat on the second day after surgery, and basically resumed normal activities on the fourth day after surgery, and the symptoms of right upper abdominal distension and discomfort were significantly reduced and the development of the disease was delayed. The patient’s abdominal CT was reviewed, and the results showed that the cyst was significantly reduced compared with the preoperative period, and the patient expressed satisfaction with the treatment effect. The patient was discharged after 1 week of hospitalization. Before discharge, the patient was asked to review regularly, usually once every six months, including liver function test and abdominal CT examination.
IV. Precautions
We are glad that the patient’s discomfort was reduced and the development of the disease was controlled after the surgical treatment. It is recommended that patients should pay more attention to rest and gradually increase the amount of food and nutrition after being discharged from the hospital. It should also be noted that since the disease is not cured, as the disease progresses, the residual cysts will continue to increase or grow, and the normal liver parenchyma will become less and less, which may lead to liver insufficiency or even liver failure, and if such a situation occurs, liver transplantation should be considered.
V. Personal insight
Polycystic liver is a congenital disease, genetically related, there is no curative medicine, if you want to cure it, you may need to do liver transplantation. However, in the early stage of disease progression, it is possible to surgically remove the cysts and preserve the normal tissues to reduce and slow down the disease progression as much as possible. Since the patient in this case did not present with liver insufficiency or liver failure, a portion of the cyst was removed after laparoscopic partial hepatectomy and laparoscopic decompression of the liver cyst, thus delaying the progression of the disease.