Incidental Finding of Ectopic Liver during Laparoscopic Cholecystectomy

Abstract

Rare co-existance of disease or pathology Background:Incidental finding of ectopic liver is gaining more attention especially during laparoscopic cholecystectomy.It is reported to be found in different locations as gallbladder, stomach, spleen, umbilical ligament and other intra-peritoneal and intra-thoracic sites. Case Reports:We present 2 cases of ectopic liver found on gallbladder during elective laparoscopic cholecystectomy for 2 Lebanese females. Our findings were consistent with previous reports. The ectopic liver tissues measured 0.9 cm and 0.5 cm respectively, which were smaller than other reports. The liver tissue lacked a biliary system, which was similar to what has been previously reported in the literature. However, no malignant histological signs were seen when excised. Conclusions:These 2 cases highlight the fact that ectopic liver tissue may be encountered on the gallbladder during laparoscopic cholecystectomy. Awareness of this potential entity is beneficial to widen the differential diagnosis when identified on imaging studies pre-operatively or when found incidentally during surgery as in this case.

Ectopic liver tissue (choristoma) on the gallbladder: A comprehensive literature review

“…The real incidence of ectopic liver tissue attached to the gallbladder wall is difficult to assess; most cases are asymptomatic and are diagnosed at laparotomy, laparoscopy, or during an autopsy[ 1 , 2 , 14 ]. However, the incidence of ectopic liver tissue has been reported to range from 0.24% to 0.47%[ 2 , 31 ].…”

“…It is usually asymptomatic and is discovered incidentally during surgery or autopsy, but there are potential complications. Torsion, malignant transformation, compression of adjacent organs, and intra-peritoneal bleeding are among the possible complications[ 1 - 72 ].…”

“…Liver tissue situated outside the liver with a hepatic connection is usually called an accessory liver, and that without a connection to the main liver, is called ectopic liver tissue. Accessory liver and ectopic liver tissues were first described by Morgagni in 1767 and by Corsy in 1922, respectively[ 1 , 20 , 36 , 72 ]. Subsequent reports showed that the accessory liver lobe most commonly occurs in the gallbladder wall, under the surface of the liver, at the gastrohepatic ligament, umbilical cord, adrenal glands, pancreas, pylorus, diaphragm, and the splenic capsule if a portion of the pars hepatica is displaced[ 28 , 31 , 34 , 44 , 36 ].…”

“…The histological architecture of the ectopic tissue resembles normal liver, although it does not have a complete functional architecture, is metabolically handicapped, and is more prone to carcinogenesis[ 2 , 6 , 36 , 40 , 62 , 72 ]. In this article, we report two cases of ectopic liver tissue and review the literature for articles published on ectopic liver tissue on the gallbladder surface or gallbladder mesentery[ 1 - 72 ]. The clinical and pathological characteristics are described in addition to an analysis of the possible clinical implications including malignant transformation.…”

Ectopic Liver Tissue Associated With the Gallbladder: Two Unique Patients and a Literature Review

“…The exact incidence is not known; however, a few studies have reported an incidence of 0.09%-0.47%. 1,2 Most patients with ectopic liver tissue are asymptomatic, and the condition is usually discovered incidentally during intraabdominal surgery or autopsy. In rare symptomatic cases, patients may present with a range of issues, from mild liver function test abnormalities to severe abdominal pain or discomfort secondary to torsion and ischemia.…”