Review for 10.1186/s12876-021-01845-y (2021)

Reviewer’s report
Title: 
Biliary peritonitis due to liver cyst rupture in autosomal dominant
polycystic kidney disease: A case report
Version: 
0 
Date: 
21 Apr 2021
Reviewer's report:
I read with great interest the case report "Biliary peritonitis due to liver cyst
rupture in autosomal dominant polycystic kidney disease". Authors described a
liver cyst rupture associated with biliary fistula complicating with biliary
peritonitis. 
This is a very interesting case reporte, but some points need to be clarifie. 
1) Firstly, the symptoms reported and the very first radiological imaging did not
show any communication between the cyst and the biliary tree; as not specified,
we assume that laboratory exams were in range and conservative therapy was
pursued with benefit. Please clarify.
2) 
Later, symptoms arose again and ascites developed. Imaging diagnosed a
biliary leak, justifying the evidence of biliary peritonitis. Anyway, it should be
clarified the time when the cultures became positive for Enterococcus faecalis,
what kind of antibiotic therapy was administered and if it resulted somehow in
improvement of laboratory data. 
3) At this point, a decision was made and surgery was performed; since it
happened on the 31st day after re-admission, one may hypothesizes that an initial
benefit was observed. If not, the authors would please better explain what other
treatment options they were evaluating before surgery. 
4) Post-operative assessment resulted in a good outcome for the patient. It would
be interesting to know if other cysts were in communication with the biliary tree
and, if present, the authors would have possibly considered deroofing them
before rupture, as elsewhere reported. 
5) Finally, it could be outlined if, on the authors' opinion, the manifestation of
such a complication in ADPKD might be an indication for liver (and kidney)
transplantation, where appropriate taking into account age and other patient
comorbidities. 
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