Laparoscopic cholecystectomy for patients with accessory liver lobe attached to the wall of the gallbladder: case reports.

BACKGROUND: Laparoscopic cholecystectomy (LC) is one of the most commonly undertaken procedures worldwide for cholecystolithiasis and cholecystitis. Accessory liver lobe (ALL) is a developmental anomaly defined as an excessive liver lobe composed of a normal liver parenchyma. Some ALL exist on the serosal side of the gallbladder. We herein present two cases of ALL incidentally detected during LC. CASE PRESENTATION: The first case was a 69-year-old woman diagnosed with chronic cholecystitis. LC was performed. ALL was observed anterior to the wall of the gallbladder and resected after clipping. Pathological findings revealed liver tissue with Glisson's capsule and a lobular structure in ALL. However, communication between the bile ducts of ALL and the main liver was unclear due to surgical heat degeneration. The second case was a 56-year-old woman diagnosed with acute cholecystitis. LC was performed approximately one month after the attack, and ALL attached to the wall of gallbladder. ALL was clipped and completely resected. Pathological findings showed that the bile ducts of ALL might be connected within the wall of gallbladder. CONCLUSIONS: We presented two cases of ALL attached to the gallbladder encountered during LC. Since ALL contains a normal liver parenchyma, postoperative bleeding or bile leakage may occur if it is inefficiently resected. Therefore, the complete resection of ALL is important to prevent these postoperative complications.

Torsion of an Accessory Liver Lobe in a Newborn.

Accessory liver lobes are rare. We present the rare case of torsion of an accessory liver lobe in a neonate. A 13-day-old newborn presented with failure to thrive and hematemesis without fever. The initial workup with sonography, magnetic resonance imaging, and upper gastrointestinal study was suspicious of a duplication cyst, most likely in the posterior wall of the stomach. Laboratory and radiological findings were not suggesting a choledochal cyst. We performed a laparotomy with resection of the 3.2 × 2.1 × 1.1 cm mass. Intraoperatively, the cystic formation extended from of the liver bed up to the lesser curvature of the stomach. The mass was attached to the left liver lobe with fibrous bands. Histopathology revealed necrotic liver parenchyma with patent viable biliary ducts, indicative of an accessory liver lobe that underwent torsion in the perinatal period. The postoperative course and follow-up (6 months so far) were uneventful. To our knowledge, this is the youngest described patient in the literature with an accessory liver lobe torsion and the second case report concerning this entity in a neonate. It presents an extremely rare differential diagnosis in symptomatic neonates with a cystic mass in the upper abdomen.

Pediculated Accessory Liver Lobe with Gallbladder in a Preterm with Umbilical Cord Hernia.

(1) Background: Accessory liver lobes are a rare finding and only a few case reports of accessory liver lobes in abdominal wall defects have been reported so far. In the case of a congenital wall defect including liver parenchyma, there is still an ongoing debate on the definition of the abdominal wall defect and best care practice. Even though congenital abdominal wall defects are frequently diagnosed in prenatal screenings, controversy on the underlying etiology, embryology and underlying anatomy remains. Prenatal distinction between omphalocele and hernia into the cord cannot always be obtained; however, due to its clinical relevance for postnatal management and counseling of parents, accurate diagnosis is essential. (2) Case Presentation: We describe the uncommon postnatal finding of a pediculated accessory liver lobe with gallbladder in a preterm with umbilical cord hernia, which was prenatally diagnosed as omphalocele. Postnatal examination revealed an amniotic sac with a diameter of six and a small abdominal wall defect of three centimeters in diameter. Postnatal management included resection of the accessory liver lobe and gallbladder and closure of the defect. (3) Results and (4) Conclusions: Throughout the literature, the distinction between umbilical cord hernia and omphalocele has been variable. This has led to confusion and difficulties regarding postnatal treatment options. In order to achieve an accurate prenatal and/or postnatal diagnosis, the morphological differences and clinical manifestation of umbilical cord hernia and omphalocele need to be assessed. Further embryological studies are warranted to understand the underlying embryological pathology of omphalocele and umbilical cord hernia and offer appropriate treatment. In consideration of possibly severe complications in the case of the torsion of a pedunculated accessory liver lobe, we strongly recommend primary removal once pre- or intraoperative identification has been made.

Surgical Dilemma: Exomphalos Major with Accessory Liver Lobe and Congenital Liver Cysts.

The association of exomphalos major, congenital liver cysts, and an accessory lobe of the liver is very rare. There are only two previously reported cases in the literature, both describing surgical excision of the accessory lobe with liver cysts during primary closure of the exomphalos defect. We report a case of this rare association, managed by delayed primary closure, where the cysts underwent spontaneous regression. This case, along with those previously reported, supports the etiopathogenesis theory of a malformative sequence of exomphalos and hepatic trauma within the sac of this rare association. Spontaneous regression of these cysts would favor a delayed primary closure in such cases.

Accessory liver lobe in the right thoracic cavity.

A healthy 42-year-old man presented to the hospital because of chest radiography performed during a medical checkup revealed a tumor. Contrast-enhanced computed tomography showed a tumor of 5 cm diameter just above the right diaphragm with blood flow from the portal vein. The patient was diagnosed with accessory liver lobe (ALL). No finding suggested malignancy, and he is being followed up. ALLs are usually found in the abdominal cavity, but they can also be found in the thoracic cavity. Although ALL is rare, it should be considered in patients presenting with intrathoracic tumors.

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

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.

A Potentially Misleading Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) typically presents in patients with a chronic liver disease and rarely develops in healthy liver, especially within an accessory liver lobe. We present a case of a healthy 64-years-old woman who showed a serum alpha-fetoprotein (AFP) value of 226.3 µg/mL during a screening blood test. Past medical history was negative for chronic liver disease or cirrhosis. Intraoperative finding was an ovaloid mass connected with the second hepatic segment by a thin pedicle of hepatic tissue. Lesion was safely resected by laparoscopic approach. Histopathology analysis showed a trabecular hepatocellular carcinoma. After a 6-month follow up, there was no evidence of recurrent disease. This case report showed how serum AFP remains a highly sensitive marker, although the presentation of HCC was unusual. To our knowledge, this is the second case reported in the literature.

A rare case of accessory liver lobe torsion in a pediatric patient who showed recurrent epigastralgia and who was treated by elective laparoscopic resection.

BACKGROUND: Accessory liver lobe (ALL) is a rare liver malformation. An ALL develops due to malformation of the endodermal caudal foregut and segmentation of the hepatic bud in the third week of gestation. Most ALLs are asymptomatic and are detected incidentally during abdominal surgery. The incidence of ALL is < 1% in patients who undergo abdominal surgery. However, some ALLs twist and cause acute abdomen. We experienced a pediatric case of ALL torsion in a patient who underwent elective laparoscopic surgery. CASE PRESENTATION: The 5-year-old girl had a 3-month history of epigastralgia and vomiting, which occurred every 2 weeks. Abdominal ultrasonography with color Doppler imaging revealed an 11.8 × 13.6 mm nonvascular lesion with mixed echogenicity near the round ligament of the liver. Enhanced computed tomography confirmed a 14 × 16 × 20 mm low-attenuation mass surrounded by a hyperdense line and disproportionate fat stranding on the right side of the round ligament of the liver. There was no ascites or hemorrhage. These findings suggested an abscess of the round ligament of the liver. Her symptoms improved with the administration of oral antibiotics; thus, we planned to perform elective exploratory laparoscopy and subsequent resection. Two trocars (5 mm) were inserted through a multichannel port device at the umbilicus and one trocar (3 mm) was inserted at the right lateral abdomen. Upon observation of the abdominal cavity, the omentum was observed adhering to the round ligament of the liver. Macroscopic observation revealed no apparent mass lesions. We performed adhesiolysis of the omentum from the round ligament of the liver using a vessel sealing system. We performed resection at the site at which adhesion had formed between the round ligament of the liver with the surrounding tissue using a vessel sealing system and the resected specimen was extracted through the umbilical wound. The postoperative course was uneventful. A pathological examination revealed necrotic liver tissue. The resected tissue was founded to be an ALL with ischemic change. CONCLUSIONS: The recurrent abdominal pain was induced by torsion of the ALL. Pediatric surgeons should consider ALL torsion as a differential diagnosis for epigastralgia of unknown etiology.

Radiographic, ultrasonographic, and computed tomographic characteristics of an accessory liver lobe in a cat.

A 5-year-old male Norwegian Forest cat presented with increased hepatic serum biochemical parameters. Abdominal radiography showed an oval cranioventral mass and ultrasound revealed a mobile mass attached to one hepatic lobe. Computed tomography (CT) confirmed that the mass was attached to the right medial liver lobe. Differential diagnoses were an accessory liver lobe, benign neoplasia, and focal nodular hyperplasia. The mass was removed and histopathology confirmed the mass to be normal liver tissue. Accessory liver lobe should be included in the differential diagnosis of a mobile cranial abdominal mass with a similar ultrasonographic or CT appearance to the liver.

Torsion of an Accessory Hepatic Lobe with Embedded Gallbladder: In an 11-Month-Old Boy.

An accessory lobe of the liver is a rare entity in clinical practice which is diagnosed incidentally. Infrequently, it may present as torsion with a clinical picture of an acute abdomen, a palpable mass, and may be associated with liver function abnormalities. Many of these patients have a history of previous surgery for congenital abdominal wall defects such as omphalocele. We present an extremely rare case of torsion of an accessory hepatic lobe in an 11-month-old male patient who presented in a state of shock. The infant underwent laparotomy and excision of the accessory lobe. Here, we aim to emphasize the importance of prompt management and early resection which is the cornerstone of a favorable outcome.

Accessory liver lobe attached to the gallbladder wall preoperatively detected by ultrasonography: A case report.

INTRODUCTION: An accessory liver lobe is a rare developmental abnormality, which is often not diagnosed preoperatively, and is usually detected incidentally during abdominal surgery. This condition is often asymptomatic; here, we report on a case where the accessory liver lobe was diagnosed preoperatively using ultrasonography. CASE PRESENTATION: A 59-year-old woman presented to our hospital with right upper abdominal pain. An abdominal ultrasonography indicated the presence of gallbladder debris and an accessory liver lobe. She underwent laparoscopic cholecystectomy and resection of the accessory liver lobe without any complications. DISCUSSION: An accessory liver lobe is a rare anomaly of the liver. It is typically asymptomatic and is detected incidentally during surgery or autopsy in most cases. However, we diagnosed the accessory liver lobe using ultrasonography. An accessory liver lobe can occasionally result in complications, such as bleeding, portal vein obstruction, or malignant transformation to hepatocellular carcinoma. CONCLUSION: An accessory liver lobe should be resected to prevent complications and malignant transformation. Ultrasonography is useful for preoperative diagnosis in cases with an accessory liver lobe.

Torsion of pedunculated accessory liver lobe with acute acalculous cholecystitis.

Accessory lobes of the liver are very uncommon and rarely symptomatic. We report the occurrence of torsion and infarction of a pedunculated accessory lobe of the liver with acute cholecystitis. The speculated possibilities of the coexistent pathologies and its management are discussed.

Surgical experiences of Ectopic Liver and Accessory Liver Lobe casese / 한국간담췌외과학회지

PURPOSE: The case of ectopic liver and accessory liver lobe have been rarely reported. A hepatic rudiment appears in the ventral angle between the foregut and the yolk sac; pars hepatica and pars cystica. The close connection between them explains accessory lobe on the Gall bladder surface wall. And the displacement of migration of a portion of the pars hepatica explains the ectopic liver. Difference between ectopic liver and accessory liver lobe can be defined whether the connection with hepatic proper exists or not. But, the definite discrimination of the type is very difficult clinically. Recently, we experienced cases of ectopic liver and accessory liver. CASES: In one patient, 43-year-old woman was referred to our department with left upper quadrant abdominal pain. Abdominal sonogram revealed a mass below the diaphragm attached to the superior pole of the spleen. On the operation, tumor mass was reddish gray colored and measured 10 7 3 cm. There were no direct connections with the liver proper except fibrous tissue, and its blood supply was considered from the left diaphragm. The pathologic result proved hepatocellular carcinoma(HCC). In the other patient, a 68-year-old woman complained right upper quadrant abdominal pain and was diagnosed as chronic cholecystitis on sonogram. During the laparoscopic cholecystectomy, a small bean sized mass, appearing as liver tissue, attached GB body portion was detected. The Mass was measured 1.0 1.0 3.0 cm in size and glistening dark brown colored, smooth surfaced. Streaky stalk connected with liver proper was visible. Pathologic finding confirmed the mass as an accessory liver. Both patients discharged without complications. DISCUSSION: Although the clinical problems are rare in the ectopic liver, it has been reported that ectopic liver is prone to be a cancer and accessory liver can induce symptoms. The larger the size becomes, the more it can be Symptomatic. Surgical treatment should be considered whenever they are diagnosed. More investigations are nedeed to know their clinical importance on the basis of the case accumulation.