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: 
23 May 2021
Reviewer's report:
I read with interest the manuscript you submitted to BMC Gastroenterology.
Please, allow me to make some comments.
Major Comment:
Unfortunately, this case presentation lacks any clinical epicrisis: for instance,
was there any sign of cyst rupture/biliary ascites at the time of the first patient
admission? Should these have been suspected at least? What do they think should
have been acted instead, in order to prevent the subsequent massive ascites
formation? Perhaps, a conclusion might be that a CW-MRI or DIC-TC is to be
recommended first in every case of biliary cyst rupture with concomitant ascites?
What about different treatment options - namely, surgery vs. a step-up approach
with non-operative approaches such as PTBD placement first? Answering these
questions can provide readers with some practical, applicable hints to be applied
in their practice should they face similar clinical dilemmas. 
Minor Comments:
1. Past medical history should be reported at the beginning of the case
presentation, in order not the distract the reader while diving into the present
medical issue (see page 5, lines 30-42).
2. What did the authors do at the time of the first hospital admission in order to
investigate and treat the ruptured cyst (namely, what does 'conservative
treatment' actually mean?).
3. At the time of the second hospital admission, when 'massive biliary ascites'
was observed, why was drainage of such initiated only after 11 days?
Subsequently, why was the patient transferred to a secondary level hospital only
after 31 days? Do the authors believe that a more rapid approach could have
improved the clinical course?
4. Was any non-operative approach considered (for instance, a percutaneous
trans-hepatic drainage of the cyst) before opting for a surgical exploration? 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes