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
×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 . 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