Dr. Demon Anderson
Simple hepatic cyst is a rare disease in childhood. They occur in the general population with a prevalence of up to 5%. The incidence and size of cysts increase dramatically in adults older than 50 years. We performed a systematic literature review of all cases of simple hepatic cysts in the pediatric population undergoing surgical treatment. We found 52 cases reported in literature with a mean age of 2.54 years, 15% were pedicled cysts and only one case reported intracystic bleeding, detected only in the anatomopathological examination. We report a case of a 13-year-old girl who was presented with a symptomatic giant solitary bile cyst, the second biggest simple hepatic cyst reported in pediatric population, the biggest pedicled cyst and the only case of intracystic bleeding detected in pre-operative image examination in this group. This case brings important considerations about this complication and its pre-operative diagnosis.
Surgery of children has been practiced since times immemorial. It is, however, only after the Second World War that it was recognized as an independent identity in the USA and United Kingdom. The rapid strides the specialty made in the west during the last six decades is, therefore, astonishing. It has been likened to the evolution of an oak tree from an acorn, growing from humble beginnings to a wellrecognized surgical specialty. Pediatric surgery as a specialty is about 45 years old in India. In the fifties of the last century, there were only three general surgeons who confined their work exclusively to pediatric surgery. They were Prof. U.C. Chakraborty at Calcutta Medical College, Dr. Raman Nair at Trivandrum Medical College, and Prof. D. Anjaneyulu at Niloufer Hospital affiliated to Osmania Medical College at Hyderabad.
The fifties were also the years of beginning of my own surgical career. Having graduated from Medical College, Amritsar, I was lucky to be appointed a Surgical Registrar to the then doyen of Surgery Prof. S.S. Anand at Medical College Hospital, Amritsar, in the mid-fifties. Children's surgery at that point of time was chiefly confined to herniotomy, suprapubic lithotomy, appendectomy and drainage of empyema. Most of the general surgeons in those days were not interested or indifferent to the management of severe congenital anomalies. At Amritsar, in the mid-fifties, babies suffering from esophageal atresia, abdominal wall defects and other severe congenital anomalies were usually sent home without surgical treatment for lack of expertise. I believe most of the other Medical Institutes had similar practice at that time. It is not surprising, therefore, that many young surgeons in the late fifties and early sixties went abroad for higher training in pediatric surgery as there were no such training centers in the country. I was fortunate to get a Colombo Plan Scholarship for higher training at Hospital for Sick Children, Great Ormond Street, London, in 1962.
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