Laparoscopic Diagnosis and Treatment of a Twisted Accessory Liver Lobe

Abstract

Accessory liver lobe (ALL) is a rare congenital abnormality characterized by the presence of hepatic tissue outside of, but attached to, the liver. ALL is usually asymptomatic, but in the case of torsion, it can be confused with an acute surgical emergency or a tumoral mass. Conventional imaging is often inconclusive, and diagnosis is generally made during laparotomy. We report the case of a patient with left ALL torsion who, for the first time, was successfully diagnosed and treated with a laparoscopic resection.

Congenital Riedel’s lobe of the liver: A case report

“…[ 4 , 5 ] These accessory lobes, composed of normal liver parenchyma, can be connected directly to the original liver, by mesentery, or by a pedicle. [ 6 ] . Patients with accessory hepatic lobes may have a history of omphalocele or gastroschisis, suggesting a relation to a malformation involving the foregut and abdominal wall.…”

Acute liver lobe torsion in a kitten

“… 7 CT may reveal enlargement or abnormal positioning of the liver lobe or a mass adjacent to the liver with low attenuation and reduced to absent contrast enhancement. 2 , 6 , 10 , 11 , 13 , 16 , 24 – 26 There has also been a report of a ‘whirl sign’ on CT findings of a dog with LLT and secondary disseminated intravascular coagulation and multiorgan infarction. 13 A ‘whirl sign’ is a CT finding described as the rotation of vessels around the point of torsion.…”

“…1,2,7,9,11,13,17,19,20,22,23 Abdominal ultrasound may reveal changes in echogenicity, decreased hepatic blood flow with color-flow Doppler, peritoneal effusion, liver mass and/or segmental hepatomegaly. [1][2][3][4][5][6][7][8][9][10][11]13,15,[17][18][19][20][22][23][24] In a previous case series study in dogs, LLT was diagnosed on Doppler abdominal ultrasound findings in five cases. 7 CT may reveal enlargement or abnormal positioning of the liver lobe or a mass adjacent to the liver with low attenuation and reduced to absent contrast enhancement.…”

“…An acute abdomen secondary to a liver lobe torsion (LLT) is rarely reported in dogs, cats, horses and humans, but is relatively frequent in the rabbit. 1 – 26 The exact cause of LLT is still unknown. There are several potential causes of LLT in dogs and cats, such as secondary to trauma, neoplasia, gastric dilatation and volvulus in dogs, abnormal hepatic ligaments or a diaphragmatic hernia.…”