Left Hepatic Lobe Torsion & Infarction, A Rare Cause of Acute Abdominal Emergency

Muhammad Afzal Randhawa, Yumna Khan, Iftikhar Ahmed and Aamrasaeed

Department of General Surgery, Bahawal Victoria Hospital, Quaid-E-Azam Medical College, Pakistan

^*Correspondance to: Muhammad Afzal Randhawa 

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Abstract:

Introduction: Hepatic lobe torsion causing abdominal symptoms can be frequently seen in dogs, rabbits and few other mammals. There are reported cases of torsion of Accessory hepatic lobes in humans. This is the first time that a case of torsion & infarction of anatomical left hepatic lobe causing acute abdominal emergency and leading to surgical exploration is being presented in a female patient.
Presentation: A 19 year old female presented with acute abdominal emergency. After initial workup we decided to do an exploratory laparotomy. During exploration, it was found that anatomical left liver lobe went into torsion/infarction resulting in capsular rupture and significant Hemoperitoneum. Left hepatic lobe was removed (left lateral tri-segmentectomy). Patient was discharged on 3rd POD without any complication during hospital stay and a normal routine follow-up.
Discussion: Rare/unusual reported causes of acute abdominal symptoms include torsion of Accessory hepatic lobes, torsion of falciform ligament, torsion of pedunculated hemangioma, rupture of Benign liver tumors, Omental torsion, Focal fat necrosis, torsion of appendix epiploicae and mesenteric panniculitis. Most cases of liver infarction occur after liver Transplantation, Hepatic artery occlusion, Trauma, Shock, HELLP Syndrome and Hyper-coagulable state.
Conclusion: A high suspicion of index should be kept for rare causes of acute abdomen, whenever there is un-usual presentation. Detailed laboratory/radiological investigations should be done in such patients. In many cases, diagnosis is usually made upon surgical exploration.

Keywords:

Torsion; Infarction; Hepatic lobe; Acute abdomen

Cite the Article:

Randhawa MA, Khan Y, Ahmed I, Aamrasaeed. Left Hepatic Lobe Torsion & Infarction, A Rare Cause of Acute Abdominal Emergency. World J Surg Surgical Res. 2019; 2: 1136.