Laparoscopic resection of a torsed accessory hepatic lobe: Case report and literature review

Accessory hepatic lobe (AHL) is a rare anatomical variant of the liver that is often asymptomatic and discovered incidentally through radiographic imaging. When pedunculated, AHL can undergo ischemic torsion, presenting as severe abdominal pain. Laparoscopic surgery provides an excellent approach to establish the definitive diagnose and excise the offending lobe. In our case, a 12-year-old boy presented with severe abdominal pain. Abdominal ultrasound and computer tomography demonstrated a mass adjacent to the liver with surrounding inflammation. The patient underwent diagnostic laparoscopy and a pedunculated AHL was discovered that had undergone 360° torsion. The ischemic-appearing lobe was resected laparoscopically without complications. Pathology confirmed hemorrhagic necrosis of otherwise normal hepatic tissue. The patient was discharged on the second postoperative day after an uneventful recovery. Due to the rarity of AHL, the definitive diagnosis of AHL torsion is typically made during exploratory laparotomy. A laparoscopic approach provides a safe and effective way to explore, diagnose and excise an ischemic AHL.