The Journal of the Arkansas Medical Society Med Journal March 2020 Final 2 - Page 14

Case Study by Abhilash Perisetti, MD; 1 Edwin Onkendi, MD; 2 Saikiran Raghavapuram, MD; 1 Benjamin Tharian, MD 1 1 Department of Gastroenterology, UAMS, 2 Minimally Invasive Gastrointestinal, 2 Hepatobiliary Pancreatic Surgery, Department of Surgery, Texas Tech University, Lubbock, Texas Massive Hepatomegaly with Gastric Compression A 40-year-old female without prior med- ical history presented with upper ab- dominal pain, postprandial nausea, and early satiety for a week. Her vitals were stable. Physical examination revealed massive hepatomegaly, with the lower edge of the liver 3 cm below the costal margin. Laboratory data were normal including liver function tests. A CT scan of the abdomen is shown (Figure 1). The patient underwent laparoscopic deroofing of the large liver cysts including the left liver 15 cm cyst that was compressing the stomach (Figures 2-4). No post-procedure complications were noted. The diagnosis is adult polycystic liver dis- ease (APLD). The CT scan shows multiple cystic masses with a large cyst in the left lobe of liver compressing the stomach causing the patient’s symptoms. 1 Only a minority of patients develop advanced liver disease or signs and symptoms of massive hepatomegaly or large cysts causing compression of surrounding structures. Patients with large-size cysts and advance liver disease rarely respond to medical therapy. Operative management for large symptomatic liver cysts includes aspiration, sclerotherapy, laparoscopic or open parenchyma-sparing de-roofing of the cyst or fenestration, and marsupialization of as many of the large cysts as possible. 2,3 Liver transplantation for a severe polycystic liver dis- ease has been described and remains the only 1. Chandok N. Polycystic liver disease: a clinical review. Annals of Hepat. 2012;11(6):819- 826. 2. Arnold HL, Harrison SA. New advanc- es in evaluation and management of patients with polycystic liver disease. The American Journal of Gastroenterol. 2005;100(11):2569-2582. 3. Chen MF. Surgery for adult polycystic liver disease. Journal of Gastroenterology and Hepatol. 2000;15(11):1239-1242. curative therapeutic option. Figure 1. Figure 2. Figure 3. Figure 4. 206 • The Journal of the Arkansas Medical Society References www.ArkMed.org