Recently, Hanh Phuc International Hospital received a 37-year-old South African patient, T.S., who presented with an atypical symptom—a pain in the left shoulder area. After a multidisciplinary consultation with general surgery specialists, the initial clinical assessment pointed to a musculoskeletal issue in the shoulder. However, doctors suspected the origin could be abdominal.

Comprehensive clinical evaluations and necessary laboratory tests were conducted. Results revealed an abnormality in the left lobe of the liver—a large hepatic cyst measuring 11x5x6cm with signs of internal hemorrhage. The clot within the cyst was causing pressure and pain for the patient.

The patient was hospitalized and received aggressive medical treatment to manage pain, control bleeding, and monitor the hematoma size. At the same time, a surgical team was on standby in case the condition progressed to a hemorrhagic liver cyst rupture requiring emergency surgery.

Imaging reveals large hemorrhagic liver cyst

After three days of intensive medical treatment, the patient’s condition stabilized. Both abdominal and shoulder pain subsided, and follow-up lab tests showed no further bleeding. The patient was discharged with instructions for home monitoring and was advised to return for a follow-up MRI scan in three months to reassess the cyst and consider potential surgical intervention if necessary.

According to Dr. Chu Minh Tuan, General Surgery Department:
“Liver cysts are more common in women, with a female-to-male ratio of 1.5:1 in asymptomatic cases and 9:1 in symptomatic or complicated cases.”

Hepatic cysts are benign liver tumors, usually asymptomatic, with an estimated prevalence of 2.5% to 4.7%. Complications occur in the following order: compression (bile ducts, blood vessels, digestive tract, lungs) in 3-9% of cases, intracystic hemorrhage in 2-5%, infection in 1%, and—more rarely—rupture into or outside the peritoneal cavity. Though generally mild and treatable, a ruptured cyst with internal bleeding can cause life-threatening hemodynamic instability, requiring urgent surgery.

Benign liver cysts may be congenital or acquired and are more common in women and the elderly. They often originate from dilated microhamartomas that do not connect to the biliary tree. These cysts are frequently discovered incidentally during routine health checks and usually do not require treatment. With today’s diagnostic imaging techniques, prevalence rates have been reported as high as 5% on ultrasound and up to 15% on CT scans.

Symptoms may include abdominal discomfort, pain, or nausea. Generally, larger cysts are more likely to cause symptoms than smaller ones. In some cases, large cysts can lead to atrophy of the affected liver lobe and compensatory hypertrophy of the opposite lobe.

According to the medical literature, 10–16% of affected patients will experience symptoms. These are typically due to the mass effect from fluid accumulation within the cyst, potentially leading to jaundice, pain, or rupture. Though rare, hemorrhage is a potential complication. When bleeding occurs, changes in the cyst’s morphology due to hemoglobin content can make it difficult to distinguish between benign cysts and more concerning conditions, such as biliary cystadenomas or cystic neoplasms, sometimes resulting in unnecessary major liver resections. Even with accurate diagnosis, treatment strategies vary widely—from observation to major liver surgery—with no consensus on optimal management for hemorrhagic liver cysts.

Expanding specialties – comprehensive care for Mothers and Babies

At Hanh Phuc International Hospital, we are continuously expanding our range of specialties to provide comprehensive care for mothers and children. In addition to our strengths in Obstetrics and Pediatrics, the hospital has invested in developing critical departments such as Surgery, ENT, and Endocrinology to better support complex medical conditions related to pregnancy and postpartum.

The case of patient T.S. highlights the importance of a multidisciplinary healthcare system. Although her initial symptoms were vague, they stemmed from a serious abdominal condition. Thanks to the close collaboration between the Obstetrics, Surgery, and Radiology teams, the hemorrhagic liver cyst—a rare but potentially life-threatening complication—was promptly diagnosed and treated.

Developing complementary specialties not only enhances our ability to handle high-risk conditions during pregnancy and postpartum but also ensures that every mother coming to Hanh Phuc receives comprehensive care. The combination of specialized medical services and personalized care delivers a safe and effective healthcare experience for every mother and baby, starting from the very beginning.

References:

1. Hepato-Biliary-Pancreatic Surgery Textbook, Department of Surgery, Ho Chi Minh City University of Medicine and Pharmacy
2. Marion Y, Brevartt C, Plard L, Chiche L. Hemorrhagic liver cyst rupture: an unusual life-threatening complication of hepatic cyst and literature review. Ann Hepatol. 2013 Mar-Apr;12(2):336-9. PMID: 23396748.
3. Fong ZV, Wolf AM, Doria C, et al. Hemorrhagic hepatic cyst: report of a case and review of the literature with emphasis on clinical approach and management. J Gastrointest Surg. 2012 Sep;16(9):1782-9. doi:10.1007/s11605-012-1922-6. PMID: 22688416.

Medical Advisor:
Dr. Chu Minh Tuan – Specialist in General Surgery

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