How much liver does a person need?

In patients who had no medical care for years, it is wise to expect the unexpected. Here, a gigantic liver cyst compressed abdominal organs, vessels, and the gut. The patient is thus far doing well in a nursing home, exemplifying the low amount of residual liver tissue necessary for survival.

CASE REPORT

Liver cysts are not an uncommon finding. In elderly patients without medical care for long time, they may reach critical diameters combined with a compression of abdominal organs, vessels, and the gut. Other potential problems are rupture or bleeding of the cyst(s) or an infection of the cyst(s).

An 82‐year‐old patient suffered a syncope and was found bedraggled at home in February 2019. The patient had hardly any social contacts in recent years and had not been to a doctor for a long time. He had anemia, but normal serum transaminase and blood coagulation levels. Only cholinesterase was reduced with 77 μkat/L (normal range: 89‐215). An ultrasonography revealed a huge liver cyst, the computed tomography scan of the abdomen revealed the cystic lesion sized 25 × 19 cm, filling almost the entire right lobe of the liver (Figure 1). It caused a diaphragmatic elevation on the right and a compression of abdominal organs. There was no hint of malignancy in other organs. The patient declined a puncture to achieve at least a transient volume relief. Surgery was not possible in his general condition.

Figure 1

Computed tomography of the abdomen, coronal section: Huge liver cyst with displacement of the upper abdominal organs, gastrointestinal tract, and intra‐abdominal vessels

Liver cysts are frequent: In an ultrasound screening by Larssen et al1 of 1541 patients, cysts are described in 11.3%. In more than 90% of cases, they were 3 cm in diameter or smaller, the incidence increasing with age. Usually, no therapy is required. In liver surgery, a residual tissue mass of 20%‐30% is considered sufficient for functional maintenance in healthy people.2 Unfortunately, self‐care by the patient was no longer possible; he was transferred to a nursing home. He is doing well there, and the case described here exemplifies how little liver remnant parenchyma is needed to survive.

CONFLICT OF INTEREST

There are no conflicts of interest.

AUTHOR CONTRIBUTIONS

IAH wrote the article and has accountability for all aspects of the work.

ETHICAL APPROVAL

The patient gave written consent to report his case and the imaging.