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CC BY 4.0 · European J Pediatr Surg Rep. 2024; 12(01): e7-e10
DOI: 10.1055/s-0043-1778663
Case Report

Torsion of an Accessory Liver Lobe in a Newborn

Tobias Krause
1   Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
,
Dietmar Cholewa
1   Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
,
Benjamin Liniger
1   Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
,
Steffen Berger
1   Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
,
Milan Milosevic
1   Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
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Abstract

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.

Keywords

accessory liver lobe torsion - hepatic lobe - neonatal liver lobe torsion - pedunculated liver lobe

Note

Torsion of accessory liver lobes should be considered a differential diagnosis in symptomatic neonates with cystic masses in the upper abdomen. Resection is feasible and safe in neonates.




Publication History

Received: 31 July 2023

Accepted: 10 December 2023

Article published online:
15 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Natarajan S, , Jayasudha, Periasamy M, Rangasamy S. Torsion of accessory hepatic lobe. J Indian Assoc Pediatr Surg 2017; 22 (01) 55-56
    CrossrefPubMedGoogle Scholar
  • 2 Nagano A, Onishi S, Kedoin C. et al. A rare case of accessory liver lobe torsion in a pediatric patient who showed recurrent epigastralgia and who was treated by elective laparoscopic resection. Surg Case Rep 2021; 7 (01) 143
    CrossrefPubMedGoogle Scholar
  • 3 Elmasalme F, Aljudaibi A, Matbouly S, Hejazi N, Zuberi MS. Torsion of an accessory lobe of the liver in an infant. J Pediatr Surg 1995; 30 (09) 1348-1350
    CrossrefPubMedGoogle Scholar
  • 4 Lin HY, Chen CC, Kong MS. Accessory lobe of the liver in a 14-year-old girl. Pediatr Neonatol 2019; 60 (03) 337-338
    CrossrefPubMedGoogle Scholar
  • 5 Wang C, Cheng L, Zhang Z. et al. Accessory lobes of the liver: a report of 3 cases and review of the literature. Intractable Rare Dis Res 2012; 1 (02) 86-91
    PubMedGoogle Scholar
  • 6 Thakral CL, Shivalingam G, Dar FM, Thakral N. Torsion of an accessory hepatic lobe with embedded gallbladder: in an 11-month-old boy. European J Pediatr Surg Rep 2017; 5 (01) e62-e64
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Carrabetta S, Piombo A, Podestà R, Auriati L. Torsion and infarction of accessory liver lobe in young man. Surgery 2009; 145 (04) 448-449
    CrossrefPubMedGoogle Scholar
  • 8 Morgagni JB. De sedibus et causis morborum. Epistolae. 1767; II: 48-55
    PubMedGoogle Scholar
  • 9 Riedel I. Über den zungenförmigen Fortsatz des rechten Leberlappens und seine pathognostische Bedeutung für die Erkrankung der Gallenblase nebst Bemerkungen über Gallensteinoperationen. Berl Klin Wochenschr. 1888; 29: 577-581
    PubMedGoogle Scholar
  • 10 Glenisson M, Salloum C, Lim C. et al. Accessory liver lobes: anatomical description and clinical implications. J Visc Surg 2014; 151 (06) 451-455
    CrossrefPubMedGoogle Scholar
  • 11 Pérez-Martínez A, Conde-Cortés J, Martínez-Bermejo MA, Bento-Bravo L. Torsion of a pedunculated accessory hepatic lobe: differential diagnosis of projectile vomiting in a neonate. J Perinat Med 2006; 34 (03) 248-249
    CrossrefPubMedGoogle Scholar
  • 12 Collan Y, Hakkiluoto A, Hästbacka J. Ectopic liver. Ann Chir Gynaecol 1978; 67 (01) 27-29
    PubMedGoogle Scholar
  • 13 Umehara M, Sugai M, Kudo D, Hakamada K, Sasaki M, Munakata H. Torsion of an accessory lobe of the liver in a child: report of a case. Surg Today 2009; 39 (01) 80-82
    CrossrefPubMedGoogle Scholar
  • 14 Pereira RM, Simões e Silva AC, Leite VH, Lanna JC, Guimarães JT. Successful management of concomitant omphalocele, accessory hepatic lobe, and biliary atresia in a 44-day-old boy. J Pediatr Surg 2005; 40 (10) e21-e24
    CrossrefPubMedGoogle Scholar
  • 15 Ito F, Ando H, Watanabe Y. et al. An accessory lobe of the liver disturbing closure of the umbilical ring. Pediatr Surg Int 1999; 15 (5-6): 394-396
    CrossrefPubMedGoogle Scholar
  • 16 Corbitt N, Rellinger EJ, Hernanz-Schulman M, Chung DH. Accessory hepatic lobes in the pediatric population; a report of three cases of torsion and literature review. J Pediatr Surg Case Rep 2017; 16: 15-18
    CrossrefPubMedGoogle Scholar
  • 17 Iwase K, Takahashi T, Higaki J. et al. Left-hand-assisted laparoscopic resection of hepatocellular carcinoma in an accessory liver. J Hepatobiliary Pancreat Surg 2001; 8 (04) 379-382
    CrossrefPubMedGoogle Scholar
  • 18 Basile A, Croatto T, Gregoris A. et al. An unusual case of primary liver cancer. Hepatocellular carcinoma in an accessory liver. Cancer 1994; 73 (05) 1332-1334
    CrossrefPubMedGoogle Scholar
  • 19 Ladurner R, Brandacher G, Mark W. et al. Complete hepatic ischemia due to torsion of a large accessory liver lobe: first case to require transplantation. Transpl Int 2005; 18 (04) 467-469
    CrossrefPubMedGoogle Scholar
  • 20 Hundal RS, Ali J, Korsten MA, Khan AM. Torsion and infarction of an accessory liver lobe. Z Gastroenterol 2006; 44 (12) 1223-1226
    Article in Thieme ConnectPubMedGoogle Scholar