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