Incidentally found Accessory Liver: A Case Report

Congenital anomalies of the hepatobiliary system are common. The accessory liver lobe is a rare clinical scenario. The cause is thought to be due to excessive liver growth. Its diagnosis is usually incidental but rarely can be symptomatic. The accessory liver lobe can be attached to liver tissue or completely separated from the liver tissue (ectopic liver). We are presenting a pediatric patient with a completely separated accessory liver lobe from the liver tissue which was found incidentally while being operated for hiatal hernia.

A 3-year-old male toddler presented with the complaint of regurgitation and vomiting of ingested matter since the age of 1 year and 8 months. The liver function test and liver enzyme were normal. An upper GI contrast study was done and the patient was diagnosed with hiatal hernia. He underwent laparotomy for the diagnosis of hiatal hernia and fundoplication was done. During laparotomy, there was incidentally found accessory liver tissue, has a similar consistency and color to liver tissue. It is completely separated from the liver with its vascular pedicle. The mass was found to be just inferior to the visceral surface of the liver with no attachment to the liver and it measures about 4* 5cm (Figure 1). The mass was submitted for histopathology evaluation and showed normal liver tissue.

The accessory liver lobe is a rare hepatobiliary system anomaly [1]. Its exact cause is unknown but it is incriminated that it is the result of embryonic heteroplasia and rarely also post trauma or surgery. The accessory liver lobe is usually found connected to the main liver tissue either pedunculated or sessile [2], but rarely found as completely separated from the main liver tissue as in our case [3]. The location of the accessory liver lobe is commonly at the subhepatic area (i.e visceral surface of the liver), but can be found at the gastrohepatic ligament, around the pancreas, spleen, gallbladder [4] or adrenal gland; Even extra- abdominal like in intrathoracic is reported [5]. Patients with accessory liver lobe are usually asymptomatic but rarely complications can occur. The reported complications are torsion (with pedunculated accessory liver) [6], traumatic rupture, infarction [7], and hepatic dysfunction with hepatocellular carcinoma [8] (more with ectopic liver i.e. completely separated accessory liver lobe). Since there are reports of accessory liver torsion and hepatocellular carcinoma risk it is better to resect it if detected intraoperatively during unrelated surgery especially if it is pedunculated or completely separated (ectopic liver) type.

The accessory liver lobe is a rare anatomic anomaly. Since the vast majority of patients with accessory liver are asymptomatic, they are commonly diagnosed during surgery. However, since there are reports of accessory liver torsion and hepatocellular carcinoma risk it is better to resect it if detected intraoperatively during unrelated surgery especially if it is pedunculated or completely separated (ectopic liver) type.

Consent for publication

Ethical approval is held to be unnecessary by St. Paul’s Hospital Millennium Medical College Institutional Review Board as this is a single rare case encountered during clinical practice.

Availability of Supporting Data

All data and materials are available upon request by the Editorin- Chief.

Competing Interests

No authors have disclosed any conflicts of interest.

Funding

Not applicable.

Authors’ Contributions

All authors contributed in different aspects. EM operated on the patient and also followed the patient. KG and AA wrote the draft of the case presentation. MT operated on the patient, wrote the case report, and is also following the patient. All authors read and approved the final manuscript.

Acknowledgments

We would like to thank the patient’s guardians for giving us consent to use both the child’s history and the picture.

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