Complete hepatic ischemia due to torsion of a large accessory liver lobe: first case to require transplantation

Abstract

Summary Anatomical abnormalities of the liver are extremely rare. Although the majority of cases with an accessory liver are not detected, it can give rise to various clinical symptoms like recurrent abdominal pain and impaired liver function. Here we present the first case of orthotopic liver transplantation in a patient with hepatic ischemia caused by complete vascular occlusion due to a twisted accessory liver lobe. Although rare, an accessory liver lobe may cause serious and life‐threatening problems and should therefore be kept in mind in patients presenting with acute abdominal pain.

Accessory lobes of the liver: A report of 3 cases and review of the literature

“…Patients with an ALL may have overt symptoms or their lives may be in danger if they have complications (39). Reported complications include reversion, infarction, hemorrhage, fracture, hemangioma, biliary atresia, gallbladder torsion, hepatic dysfunction, diaphragm defects, and acromphalus (40).…”

Torsion of accessory hepatic lobe

“…There are only a few reported cases of asymptomatic AHL. [23] Currently, there are two hypotheses of the mechanism of an AHL: (i) The embryonic liver curls outward and forms an accessory lobe during the embryonic stage of development or (ii) an accessory lobe arises from intra-abdominal hypertension caused by the development of the tunica muscularis recti and the enlargement of the liver. [4] An accessory liver is adjacent and attached to the liver by its own mesentery while an ectopic liver is one that is completely detached from the normal liver parenchyma.…”

“…[4] Symptomatic AHL has been reported in neonates, as well as in patients presenting late in the third decade of life, commonly from torsion. [36] The usual presentation is an acute abdomen, with right upper quadrant pain, with or without a palpable mass. Timely surgical intervention is warranted when an AHL undergoes torsion.…”

Intermittent torsion of accessory hepatic lobe: An unusual cause of recurrent right upper quadrant pain

“…[12] There are only a few reported cases of a symptomatic accessory hepatic lobe. Most of these are diagnosed at surgery in patients presenting with nonspecific complaints of recurrent abdominal pain and impaired liver functions.…”

“…Most of these are diagnosed at surgery in patients presenting with nonspecific complaints of recurrent abdominal pain and impaired liver functions. [12]…”