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Torsion of an accessory hepatic lobe mimicking a mesenteric tumor

Accessory hepatic lobes are rare abnormalities, usually discovered incidentally. Preoperative diagnosis is difficult and rarely made. Accessory hepatic lobes can mimic several types of tumors. Torsion is one possible complication, and in our female patient, mimicked a mesenteric tumor at imaging. This patient presented with acute abdominal pain, initially epigastric and then generalized, associated with vomiting. Laboratory tests were normal. Abdominal ultrasound investigation revealed a large abdominopelvic mass, suggestive of a mesenteric tumor. CT scan showed a 201 ×100 ×178 mm, intraperitoneal tumor mass located laterally, displacing the digestive structures, suggestive of a mesenteric tumor; the density was inhomogeneous, but the contours were regular and sharply defined (Fig. 1). At laparotomy, a voluminous pediculized mass, turned clockwise twice on its axis, was found hanging from segment III (Fig. 2). The pedicle contained dilated varicose veins. Coloration and consistency of the parenchyma were similar to the normal liver; there were no signs of vascular compromise. Left lobectomy, removing the mass, was performed and the postoperative course was uneventful. Pathohistology revealed macrovacuolar steatosis with aseptic focal necrosis, without signs of neoplastic or any other specific disease. Accessory hepatic lobes can be distinguished from other ectopic lobes by the presence of a connecting pedicle between the lobe and the liver [1]. They become symptomatic only when complications arise: bleeding, torsion, degeneration or traumatic injury [2,3]. In our case, neither ultrasound, CT scan, nor laparoscopy could affirm the hepatic origin of the mass. The excessive weight of this mass could be explained by long-standing torsion leading to hypertrophy of the accessory lobe [1,3]. Substantially dilated varicose veins in our patient led us to perform a formal lobectomy to avoid the risk of hemorrhage.

Auteur(s) : M. Cissé, O. Ka, I. Ka
Pages : e73—e74
Année de publication : 2012
Revue : Journal of Visceral Surgery
N° de volume : 149
Type : Article
Mise en ligne par : KA Ousmane