Infarcted accessory liver lobe in a pediatric patient: A case report

Abstract

Accessory liver lobe (ALL) is a rare abnormality of the liver that occurs during the third week of pregnancy due to the division of the hepatic bud and distortion of the endodermal caudal foregut. ALLs are typically asymptomatic. However, they can become twisted and cause acute abdominal pain. There have been 24 reported cases of ALL torsion in children, most of which required urgent surgical removal. A seven-year-old boy presented to the emergency room with one day of abdominal pain in the epigastric and right hypochondrium areas. Upon physical examination, localized rigidity was observed in the upper hemiabdomen, CT scan revealed a mass originating from the liver. Based on the clinical examination and the CT findings a diagnosis of acute abdomen was made and the patient underwent an emergency laparotomy. During the operation, a mass was found to be connected to the liver through a twisted pedicle. The pedicle was transected, and the mass completely removed. The histopathology report confirmed that the mass was an infarcted ALL and ruled out thrombosis or a neoplasm. Postoperatively the patient developed a bile leak at the base of the transected ALL pedicle, which was managed with a Roux-en-Y hepaticojejunostomy. Making a definitive diagnosis of ALL before surgery may be difficult, even with advanced imaging. Pediatric surgeons should include ALL torsion in the differential diagnosis of acute abdominal pain in children when a mass adjacent to the liver is found on the preoperative images.