Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most commonly inherited kidney disease and is associated with cystic manifestation in the liver. Patients with ADPKD are at higher risk for hernias, here we present an image of an incisional hernia full of multiple liver cysts.
Keywords: abdominal hernia, autosomal dominant polycystic kidney disease, hernia, incisional hernia, liver cysts
A rare case of incisional hernia full of liver cysts forming a subcutaneous mass of 14 × 14 × 4 cm.
A 49‐year‐old man with autosomal dominant polycystic kidney disease (ADPKD), was enlisted in 2015 for kidney transplantation and underwent native kidneys nephrectomy in order to avoid potential negative consequences on the outcome of the kidney graft. Unfortunately, the transplantation was postponed due to the occasional finding of clear cell renal carcinoma from the histological examination of the surgical sample. The patient is currently enlisted for a combined liver and kidney transplantation and is undergoing weekly large volume paracentesis and dialysis sessions. As for the standard procedure of patients' assessment for kidney–liver transplantation, the patient underwent a contrast‐enhanced computed tomography (CT) of the abdomen which showed an incisional hernia of the anterior abdominal wall (Figure 1).
FIGURE 1.
Axial (A) and sagittal (B) CT images showed an incisional hernia of the anterior abdominal wall. Through the narrow neck, there is herniation of multiple liver cysts with irregular septa (arrows) forming a subcutaneous mass of 14 × 14 × 4 cm. Of notice, the right liver almost completely substituted by multiple cysts with irregular septa and calcification. The patient presented also an omental umbilical hernia.
Autosomal dominant polycystic kidney disease is the most commonly inherited kidney disease and is associated with cystic manifestation in other organs such as the liver and the pancreas. The cyst burden, determined by the number and volume of cysts, increase with age, with an average 0.9%–3.2% increase in liver volume per year. 1 Patients with ADPKD are at higher risk for hernias, especially umbilical and inguinal hernias, given the increased intra‐abdominal pressure from the cysts burden. In particular, 45% of patients with ADPKD‐related end‐stage renal disease may develop abdominal hernias if compared to patients with other etiology of end‐stage renal failure. 2 To date, there is only one previous report of a single liver cyst umbilical hernia. 3 However, this is the first report of multiple liver cysts incisional hernia.
AUTHOR CONTRIBUTIONS
Mauro Giuffrè, Martina Budel, Paola Martingano, and Lory Saveria Crocè discovered the radiological finding; Paola Martingano performed CT scan reconstruction; Mauro Giuffrè, Martina Budel, Paola Martingano, and Lory Saveria Crocè drafted the manuscript; Mauro Giuffrè, Martina Budel, Paola Martingano, and Lory Saveria Crocè approved the final version of the manuscript.
FUNDING INFORMATION
The authors did not receive any funding for the present work.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
CONSENT
Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.
ACKNOWLEDGMENT
The authors would like to acknowledge the support provided by the medical and nursing staff of the Liver Clinic (Trieste University Hospital).
Giuffrè M, Budel M, Martingano P, Crocè LS. Incisional hernia by liver cysts. Clin Case Rep. 2022;10:e06491. doi: 10.1002/ccr3.6491
DATA AVAILABILITY STATEMENT
Not applicable.
REFERENCES
- 1. Temmerman F, Missiaen L, Bammens B, et al. Systematic review: the pathophysiology and management of polycystic liver disease. Aliment Pharmacol Ther. 2011;34:702‐713. doi: 10.1111/j.1365-2036.2011.04783.x [DOI] [PubMed] [Google Scholar]
- 2. Morris‐Stiff G, Coles G, Moore R, Jurewicz A, Lord R. Abdominal wall hernia in autosomal dominant polycystic kidney disease. Br J Surg. 1997;84:615‐617. doi: 10.1002/bjs.1800840509 [DOI] [PubMed] [Google Scholar]
- 3. Pansari M, Rawlinson RD, Rubay D, Genuit T, Ross A. A case report of a ventral hernia containing a liver cyst in a patient with autosomal dominant polycystic kidney disease. Cureus. 2020;12:1‐6. doi: 10.7759/cureus.6573 [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Not applicable.