Obstructive jaundice induced by postoperative intra-cystic infection with polycystic liver disease: a rare case report and literature review

Introduction and importance: Polycystic liver disease (PLD) is a rare genetic disease characterized by progressive development of cholangiocyte-derived fluid-filled hepatic cysts, and obstructive jaundice is a rare complication of PLD. Case presentation: A 72-year-old man presented with obstructive jaundice and bile-like pleural effusion following an initial laparoscopic fenestration and drainage of hepatic cysts. Upon admission to our hospital, imaging revealed an enlarged cystic lesion in segment S7 and some small cystic lesions around the liver with intrahepatic bile duct dilation. Further evaluations, including enhanced computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography computed tomography with 18-fluorodeoxyglucose ( 18 FDG-PET/CT), confirmed a large cystic lesion compressing the hepatic portal bile duct. After a multidisciplinary discussion, percutaneous transhepatic cholangiography and drainage (PTCD) was performed to temporarily alleviate jaundice. When jaundice subsided, a right hepatic resection was performed, with pathology confirming a fibrous tissue cystic wall-like structure. Clinical discussion: Our case demonstrates that laparoscopic fenestration and drainage surgery has certain limitations in the treatment of PLD. Especially for cases where the cyst is close to the hepatic hilum, it is prone to cause unpredictable complications. For elderly patients, hepatectomy is an effective treatment method and which can achieve satisfactory clinical results. Conclusions: Obstructive jaundice is a rare complication of PLD. A case of obstructive jaundice caused by an intra-cyst infection after fenestration has not been reported previously. This case highlights the need for a suitable therapeutic method for PLD with a large cyst in the hilar region.