A liver (hepatic) cyst is an abnormal fluid-filled sac that develops within the liver tissue. Hepatic cysts are relatively common, with a global prevalence of 5–18%, and are overwhelmingly benign in nature. The majority are discovered incidentally during abdominal ultrasound or CT scans performed for unrelated conditions. While most cysts require no treatment, those that grow large or become complicated can cause significant discomfort and may warrant surgical intervention
Symptoms
Most patients with hepatic cysts remain completely asymptomatic for years. When symptoms do occur usually once the cyst exceeds a significant size, they may include:
Dull, aching pain or heaviness in the upper right abdomen
Abdominal bloating and a sensation of fullness
Nausea, especially after meals
A palpable lump or swelling beneath the right rib cage
Shoulder tip pain (if the cyst presses on the diaphragm)
Diagnosis
Diagnosis is primarily confirmed through imaging:
Ultrasound: first-line investigation; shows the cyst's size, location and wall characteristics
CT Scan: provides detailed anatomical mapping, especially useful before surgery
MRI: used to distinguish complex or echinococcal cysts from simple benign ones
Blood tests: echinococcal serology (ELISA) is done if parasitic origin is suspected
Treatment
Observation (Watch & Wait)
Small, asymptomatic simple cysts do not require treatment and are monitored with periodic ultrasound every 1–2 years.
Laparoscopic Fenestration (Surgical Deroofing)
The preferred surgical treatment for large, symptomatic simple cysts. Through 2–3 small incisions, the surgeon removes the exposed roof of the cyst using a laparoscope, allowing the fluid to drain and preventing re-accumulation. This minimally invasive approach offers:
Rapid recovery (2–3 days hospital stay)
Symptomatic relief in the vast majority of patients
Low recurrence rate (~9.6%)