Simple liver cyst complicated by fistula into abdominal wall: a case report

UNLABELLED: Benign, fluid-filled lesions called simple liver cysts are commonly seen incidentally on imaging. While they are usually asymptomatic, they can cause complications including infection, rupture, or hemorrhage. The formation of a fistula into the abdominal wall is a rare complication, with diagnostic and therapeutic challenges.

CASE PRESENTATION: In April 2024, a 29-year-old obese (body mass index 30.56) male presented to Madinat Zayed Hospital with left pneumonia, which was resolved with intravenous antibiotics. A subsequent CT scan, however, showed an 11×10×5 cm hypodense lesion in the right hepatic lobe, with partial marginal calcification but no significant contrast enhancement. Differential diagnoses included hydatid cyst and biliary neoplasm. The findings in the laboratory were normal hepatitis markers and tumor markers except for elevated CA19-9 levels. Laparoscopic deroofing of the cyst revealed a 15×15 cm cyst adherent to the liver and abdominal wall containing 400 ml of bile. There was histopathological confirmation of a benign biliary cyst. The patient recovered well postoperatively and did not have recurrence or complications on follow-up.

CONCLUSION: This is a rare case of a simple liver cyst complicated by a fistula into the abdominal wall. Successful outcome resulted from multidisciplinary management using imaging, laboratory investigations, and surgical intervention. It is important to consider rare complications of liver cyst management to provide optimal patient care and this report highlights the importance of this.