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

Accessory Lobe of Right Liver Mimicking a Pulmonary Tumor in an Adult Male

Accessory liver lobes (ALL) are defined as supranumerary liver lobes, composed of normal liver parenchyma in continuity with the liver, in contrast to ectopic liver lobes (ELL) that have no anatomical continuity with the normal liver. Case report: In this article we report on a rare radiological diagnosis of an synchronous accessory and ectopic liver lobe using ultrasonography (US) and computed tomography (CT). A 59-year-old female with no symptoms was admitted to our hospital due to preventive exam. Abdominal ultrasonography revealed a high echoic 6 cm x 5 cm soft tissue area in right anterior subhepatic space with distinct margins, a uniform echo and blood flow and was suspected to be abdominal tumor. An enhanced abdominal computed tomography (CT) showed the irregular 65 mm x 48 mm x 32 mm mass in the right hypochondrium below IV and V liver segment with clear margins, a uniform density, texture and contrast enhancement as normal liver tissue. In same patient CT also showed small 16 mm x 12 mm mass in posterior mediastinum in right retrocrural space so diagnosis of accessory and ectopic liver lobe was confirmed. An accessory liver lobe is adjacent and attached to the liver by its own mesentery, while an ectopic liver lobe is one that is completely detached from the normal liver parenchyma. Conclusion: Ultrasound can show mass in the abdomen, which is most commonly in the subhepatic area, but very rarely can initially diagnose ALL or ELL due to different echogenicity of the liver parenchyma in different acoustic windows. In the case of an atypical CT presentation, an MR examination of the abdomen is indicated but it is very rarely. Fast and accurate radiological diagnosis of ALL and ELL is important in the prevention of unnecessary invasive diagnostic procedures such as laparotomy and thoracotomy which are needed only in cases of complications.

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

Introduction:Accessory liver lobe (ALL), an autonomous island of normal liver parenchyma, is a rare congenital anomaly that is difficult for preoperative diagnosis and often identified incidentally. It can also be accompanied with benign or malignant diseases, which is extremely rare. There are only 3 cases of focal nodular hyperplasia (FNH) detected on ALL reported by previous literature.Patient concerns:A 33-year-old woman was incidentally diagnosed with a mass in left upper quadrant abdomen by a routine ultrasound examination. Doppler ultrasound revealed that the mass was attached to left liver lobe with a vascular pedicle. A spoke-wheel artery with diffuse enhancement during hepatic arterial phase was visualized on contrast-enhanced ultrasound, and the mass was continuously hyper-enhanced with a hypo-enhanced intralesional scar during the portal and delayed phase. And contrast-enhanced computed tomography showed a similar enhancement mode of the mass.Diagnosis:The mass was resected and postoperative histopathologic result of the lesion revealed a nodular hyperplastic parenchyma with a central fibrous scar, without tumor cells. And a final diagnosis of FNH on ALL was determined accordingly.Interventions:Mass resection was conducted according to patient's demand.Outcome:After general postoperative administration, the patient was discharged. Then, she had been undergoing regular serological tests and imaging examinations in our hospital for 24 months.Conclusion:The finding of a mass connecting with liver by a stalk should alert the clinician of the possibility of ALL, as well as benign or malignancies on an ALL. This is the first case of FNH on ALL preoperatively confirmed by contrast-enhanced ultrasound. We suggest that an integrated radiologic approach is crucial to evaluate an incidentally detected, asymptomatic abdominal focal mass.

Incremental Value of Live/Real-Time Three-Dimensional Transesophageal Echocardiography Over the Two-Dimensional Technique in the Identification of Accessory Liver Lobe Presenting as a Right Atrial Mass

The liver can present a number of congenital anomalies. More common among them are the irregularities of the shape and the number of lobules. The less common variations include the presence of accessory lobes or accessory livers. The accessory lobes may be attached to the liver through a mesentery or a bridge of the hepatic tissue and they are usually asymptomatic. An accessory liver lobe is a very rare occurrence and when it exists, it becomes clinically important because of its rarity. We are reporting here the presence of a very small accessory liver lobe and have discussed its clinical relevance. We observed a mini liver lobe which was situated in the posterior part of the fissure for ligamentum teres. It was triangular in shape and about one inch in width. It was attached to the left anatomical lobe of the liver through a vascular pedicle which contained the branches of hepatic artery and portal vein and hepatic duct. Histological sectioning revealed the normal liver architecture in the accessory lobe. The knowledge of this accessory lobe could be of use to surgeons and radiologists.

The accessory liver lobe (ALL) of the gallbladder wall is rare, mentioned by Meckel since 1822. We present two cases of ALL occurring in two adult women. The ALLs were diagnosed at microscopic examination of cholecystectomy specimens for lithiasic cholecystitis and were located at the gallbladder body level. They measured 0.5 and 1.1cm and were pediculated from the gallbladder serosa. Luschka duct complexes were seen in the adjacent subserosa in one of the cases. The main clinical relevance of ALL of the gallbladder resides in the differential diagnosis with a lymph node and in the risk of peroperative hemorragia or bile leakage by sectioning of the connecting blood vessels and/or bile duct. Intraparietal ALL may interfere with dysmotility, possibly resulting in bile stagnation and stone formation.

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

Hernia of umbilical cord containing an accessory liver lobe and the gallbladder: A case report

An 8-year-old spayed female mixed-breed dog was presented with dysorexia, vomiting and diarrhoea lasting 10 days. Physical examination, haematology and serum biochemistry were unremarkable except for a mild hypoglycaemia and alkalosis. An abdominal ultrasound revealed no specific gastrointestinal pathological features but an unusual perisplenic parenchymal structure. The mass was clearly separable from the splenic tail, showing a coarser texture than that of the spleen and a mixed echogenicity due to the presence of both hyper- and hypo-echoic areas. A vascular pedicle connecting the left lateral liver lobe to the mass was hypothesised (Fig 1A) and confirmed by colour Doppler ultrasound (Fig 1B). A tentative diagnosis of a degenerated pedunculated accessory liver lobe was made; the CT confirmed both the perisplenic soft tissue structure with attenuation and contrast enhancement similar to that of liver except for a focal hypodense area and the vascular pedicle (Fig 1C). Fine-needle aspirate of the mass was obtained and cytology was consistent with hepatocellular hyperplasia with moderate-to-high degeneration. The gastroenteric symptoms resolution with supportive treatment coupled with the accessory liver lobe hepatocellular degeneration benign nature and the absence of relevant blood analysis abnormalities led to the patient discharge upon owner's decision. Accessory lobes are well differentiated from ectopic liver tissue in the human medical literature and pedunculated accessory lobes are defined as such if a pedicle is present. To our knowledge, this is the first description of a non-complicated abdominal degenerated accessory liver lobe joined to the left lateral hepatic lobe with a vascular pedicle. G.B. contributed to data collection (clinical investigation) and writing. T.B. and A.Z. contributed to data collection and writing. G.B. contributed to data collection, writing and revision of the manuscript.

Accessory liver lobe is attached to main liver, and different from ectopic liver which is detached from main liver. Accessory liver lobes are incidentally noted at operation or necropsy in most cases. We reported 7 cases with accessory liver lobe diagnosed by laparoscopy. The cases were of 22 to 63 years old, including 6 females and one male. The biopsy diagnosis of main liver was chronic hepatitis in 4 cases, acute hepatitis, drug-indused hepatitis and autoimmune hepatitis in 1 case each. These accessory liver lobes were attached to quadrate lobe (S4) in 4 cases, and left liver lobe (S3) in 3 cases. Accessory liver lobes measured 3mm minimum and 10mm maximum in size. In shape, they were tongue-like in 3 cases, semioval and hemispherical in 2 cases each. All of them could not be demonstrated by ultrasonography and CT, and were asymptomatic.

We report a rare case of an accessory lobe of the liver in the right thoracic cavity with the past history of breast cancer. A 66-year-old woman underwent thoracotomy owing to a slowly growing suspected lung tumor identified by computed tomography. The intraoperative findings revealed an accessory lobe of the liver. If this possibility had been considered, the correct diagnosis could have been achieved using computed tomography with multi-directional scanning, so that an unnecessary operation could have been avoided.

An accessory liver lobe (hepar succenturiatum) is encountered more often on the right side. It is connected to the right liver lobe by a stalk containing blood vessels and bile ducts. The accessory lobe may be located beneath or above the diaphragm. Usually this malformation is asymptomatic. However, torsion of the stalk may lead to acute right upper quadrant pain, nausea and vomiting. Accessory liver lobes are very rare and are encountered more often in women. Congenital hepar lobatum with the formation of abnormal, coarse lobes may be regarded as an abortive form of an accessory liver lobe.

(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.

Background: Accessory Hepatic Lobe (AHL) is a rare congenital anomaly that consists of the presence of a supernumerary lobe of hepatic parenchyma. The incidence of AHL is less than 1%, with only 27 cases having been reported in the paediatric population to date. Aim: To identify studies in the literature on accessory hepatic lobe and present our experience with this condition. Material and methods: We report the case of a patient who underwent surgery for intestinal occlusion and was found to have an accessory liver lobe with an embedded gallbladder. We reviewed published articles on accessory hepatic lobes accessed via PubMed, Google Scholar, Science Direct and Web of Science. Keywords included accessory hepatic lobe, ectopic liver tissue, ectopic liver lobe, accessory liver lobe. The search included articles published before August 2021 in English. Results: We identified 27 published cases of paediatric accessory hepatic lobe. Of these 27, 14 were female and 13 were male, and the age range was 1 day to 19 years. We report the case of a female patient with intestinal occlusion found to have an accessory hepatic lobe with an embedded gallbladder. Of the 28 published cases, including ours, 11 are associated with abdominal wall defects including Umbilical Hernia, Omphalocele, Cloacal Exstrophy and Beckwith Wiedemann syndrome. Conclusion: Accessory hepatic lobe is a rare entity usually detected incidentally. A total of 28 cases were reported, including our own. Paediatric surgeons should be aware of this condition in children with a history of abdominal wall defects.