Because of the patient's poor cardio-pulmonary status, partial hepatectomy was deemed inadvisable. During the following two years, the cyst was drained by aspiration on five occasions of volumes ranging from 800 to 1,500 ml. Each time the fluid had the same characteristics as the original. The serum bilirubin level was normal on each occasion.
The last hospital entry occurred two years later, at which time the patient vomited a dark fluid which resembled the previous cyst aspirates. There was diffuse guarding of the abdomen, with maximal tenderness in the right upper quadrant.
Roentgenographic studies revealed a pressure defect on the lesser curvature of the stomach due to the cyst, but no fistulous communications between cyst and gastrointestinal tract could be demonstrated. Diagnoses of hepatocysticenteric fistula and of perforation of the cyst into the peritoneum were made. The patient was treated with antibiotics, steroids, and drainage by canula of the hepatic