Management of cystic hepatic lesions in children

ABSTRACT

Cystic hepatic lesions in children pose diagnostic and therapeutic dilemmas. During 1996 and 1997, 12 children with liver cysts were managed at Al Noor Specialist Hospital, Makkah, Saudi Arabia. There were 7 boys and 5 girls with a mean age at presentation of 6 years [range 8 months to 13 years]. Abdominal mass was the main presentation. The diagnosis of these lesions has been aided by serological tests for hydatid disease and by abdominal ultrasonography and Computed Tomography. Total surgical excision was the definitive treatment for 7 patients and histopathological examination of the removed specimen proved that 3 were hydatid cysts, 3 mesenchymal hamartomas and 1 simple solitary non-parasitic cyst. No mortality occurred in our operated cases. The remaining 5 patients were followed-up. Two had small simple intrahepatic asymptomatic solitary cysts. The third had childhood polycystic disease of the liver and died after 6 months due to hepatorenal failure. The fourth had adult-type polycystic disease of the liver and kidneys, the fifth had traumatic liver cyst and both are being followed up. Ultrasonography, C.T. and new serological tests for hydatid disease have simplified the diagnosis of these cases. Total surgical excision remains the mainstay of cure for large symptomatic hepatic cysts. Children with asymptomatic, solitary, small, intraparenchymal cysts and those with polycystic disease of the liver, are best managed conservatively