The liver twist: A case of accessory liver lobe torsion presenting after mild trauma

Abstract

An accessory liver lobe is a congenital anomaly of hepatic tissue most commonly due to embryonic heteroplasia. Rarely, accessory liver lobes can undergo torsion and present as an acute surgical emergency. Although common in certain animals, there are only a few reported cases of accessory lobe torsion in humans. We report a multi-modality radiographic diagnosis of an acute torsion and subsequent infarct of an accessory liver lobe following minor trauma in a 29-year old male patient.

Possible Hepatic Torsion, a Pediatric Patient With Polycystic Kidney Disease

“…However, radiologic changes from hepatobiliary involvement are often not seen until disease progression. 3,4,[6][7][8] In this case, the patient was noted to have biliary tree dilation by ultrasound and splenomegaly with thrombocytopenia thought to be from splenic sequestration, indicating hepatic involvement. Despite hepatic involvement, hepatic synthetic function was normal as indicated by normal INR, thus excluding liver dysfunction or coagulopathy as an etiology of the patient's intra-abdominal bleeding.…”

“…9,10,19 Patients with hepatic torsion are at risk for hepatic infarct, hepatic rupture, hemangioma, biliary obstruction, colonic obstruction, and gallbladder torsion. [8][9][10][11][12] Symptoms concerning for further complication from hepatic torsion should be monitored following suspected diagnosis and include new-onset abdominal pain, nausea, vomiting, anorexia, pallor or decreased hemoglobin secondary to hypovolemic shock, impairment of liver function reflected in labs, and cholestasis reflected in stool quality and labs. 20 Otherwise, asymptomatic occurrences should only be excised if the liver lobe is pedunculated or in close proximity to either the cystic duct or common bile duct.…”

Case report: A case of giant accessory hepatic lobe torsion combined with left hepatic vein branch thrombosis in a child

“…MRI indicates superior diagnostic value to CT, as the vascular system extending from the healthy liver through the stalk into the giant AHL is more likely to be detected by dynamic contrast-enhanced MRI ( 2 ). However, it has been suggested that for complete stalk torsion, a contrast enhancement CT scan, especially CTA, is more useful than ultrasonography for diagnosis ( 14 ). Ultrasonography, plain CT scan, and MRI have also been reported to be non-specific for diagnostic imaging findings in pediatric AHL patients ( 5 ).…”

Atrophy of the Left Hepatic Lobe Causing Twisting of the Right Hepatic Lobe and Biliary Compression with Radiological Findings : A Case Report

“…A history of trauma and surgery involving the abdominal wall with the new development of acute symptoms such as abdominal pain in patients with an accessory liver lobe should highly suggest liver torsion. This should subsequently allow for a rapid transition to surgery to attempt to repair the torsion with the segments that probably become ischemic [1].…”

“…However, CT scan and CTA are the primary choices of imaging modality to evaluate liver lobe torsion. These tools increase the likelihood of appropriate diagnoses and increases the possibility of restoring health to the ischemic lobe or segment [1]. The clinical signs of hepatic lobe torsion may vary, with some cases being either subclinical or resulting in death.…”