Wandering liver and intestinal malrotation: first report

Abstract

A wandering liver is a rare development in both the adult and pediatric population where the liver is freely displaced along a transverse axis. We describe the first known occurrence in published literature of a wandering liver in an adult individual who also had an intestinal malrotation complicated by a midgut volvulus. The abnormal ability for a liver to wander presents a highly unusual anatomy that can be disorienting. Laparoscopic surgery is a viable option in reducing a midgut volvulus and addressing an intestinal malrotation in the presence of a wandering liver. This unusual presentation educates clinicians to avoid potential misdiagnosis given the abnormal location of the duodenum, appendix, liver, and gallbladder.

An adult presentation of midgut volvulus secondary to intestinal malrotation: A case report and literature review

“…The average age of presentation was 40 years old and there was a 1.7:1 ratio of male to female preponderance [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. The most common presenting symptoms were severe epigastric or umbilical pain, nausea and vomiting and distension; and all these symptoms were experienced by the patient in this case report [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. Diagnosis of the midgut volvulus was predominantly made via CT (67%) but also made via ultrasound (15%) and intra-operatively (18%) [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] ...…”

“…In the presence of midgut volvulus, there is a high risk of bowel ischaemia and necrosis to the bowel supplied by the SMA (35). Of the 92 midgut volvulus cases, 19% required a bowel resection, with an average resection length of 121 cm [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. There was an associated 5% mortality with midgut volvulus [ 4 , 8 , 10 , 12 , 15 , 17 , 18 , 21 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ].…”