A Case of Accessory Hepatic Lobe Torsion With Gallbladder Bed

Abstract

We report a case of accessory hepatic lobe torsion accompanied gallbladder torsion. A 14-year-old boy was admitted to our hospital after surgery for cloacal exstrophy. He was transported to our hospital with sudden upper abdominal pain. Computed tomography scans revealed dilatation of the gallbladder and swelling of the wall. Moreover, a low-density mass existed in contact with the gallbladder. We suspected gallbladder torsion and omental torsion on the basis of image findings. Thus, we performed emergency surgery. We decided to perform a laparotomy with a right oblique incision because he had a history of ileal colostomy on his right abdomen and part of the urinary tract was on his left abdomen. We found a congestive liver and an enlarged gallbladder under the wound. We diagnosed him as having accessory hepatic lobe torsion and gallbladder torsion. The congestion was improved after the torsion was released. The accessory hepatic lobe and gallbladder were removed because of possible recurrence. His postoperative course was good, and he was discharged on the fifth day after the operation. Reports of twisting of the accessory liver lobe and gallbladder are rare. If the gallbladder torsion is suspected on the basis of CT images and a mass is found near the gallbladder, we should consider the presence of accessory hepatic torsion. Moreover, because all cases of twisted accessory hepatic lobe and gallbladder have a history of abdominal wall surgery, it may be necessary to keep in mind the accessory hepatic lobe during anterior abdominal wall surgery.