Simple hepatic cyst is not always simple - a case report of cystobiliary communication requiring hepatic resection.

BACKGROUND

Simple hepatic cysts are common and usually asymptomatic, but rarely may communicate with the intrahepatic biliary tree; unroofing alone can then result in postoperative bile leakage if this communication is not recognized.

CASE PRESENTATION: We report a 74-year-old woman with multiple hepatic cysts, the largest measuring 11 cm and causing extrinsic gastric compression. Preoperative computed tomography (CT) suggested a simple cyst without evidence of biliary communication, and laparoscopic unroofing was planned. Needle decompression, however, yielded bile-like fluid indicating unsuspected cystobiliary communication; the procedure was therefore converted to laparoscopic left lateral sectionectomy. Her postoperative course was uneventful, without bile leakage.

CONCLUSION

In conclusion, a preoperatively "simple" hepatic cyst may harbor unsuspected cystobiliary communication that CT alone can miss. Intraoperative vigilance and willingness to convert to formal resection are essential when this complication is encountered.