WOFAPS 2025 8th World Congress of Pediatric Surgery

Miriam N. Maestre-Martinez, Maria Lopez-Canelada, Irene Diez-Bartolomé, César Oterino, Ane Andres, Alba Sanchez-Galan, Francisco Hernandez-Oliveros

Hospital Universitario La Paz

INTRODUCTION

Several anatomical variants of the liver have been described, most of which are identified incidentally. Torsion of a hepatic lobe is an exceptionally rare condition that can lead to a potentially life-threatening surgical emergency.

CASE

We present the case of a 6-year-old girl who underwent surgery at birth for an omphalocele containing hepatic tissue and had remained asymptomatic since then. She presented to the emergency department with a 24-hour history of abdominal pain, vomiting, and a palpable mass in the right hypochondrium and flank. Laboratory tests revealed leukocytosis, elevated lactate and CRP levels, coagulation abnormalities, and increased transaminases. Abdominal ultrasound and CT scan identified the gallbladder and what appeared to be the left hepatic lobe in an abnormal position, teardrop-shaped and located caudally to the right lobe, with signs of diffuse ischemia and absence of portal, arterial, and suprahepatic blood flow.

Urgent laparotomy revealed a completely separated and torsioned hepatic mass, corresponding either to a lobulated segment IV or a variant of Riedel’s lobe, twisted around its vascular pedicle. The left hepatic lobe was nearly absent, and intestinal malrotation was observed. Detorsion and resection of the necrotic mass were performed after meticulous dissection of the pedicle, preserving the vascularization and biliary tract of the remaining right liver.

CONCLUSION

Although extremely rare, hepatic lobe torsion is a possible and important differential diagnosis in cases of acute abdomen with a palpable mass

Patients with congenital midline defects may present with hepatic fixation and morphological anomalies that predispose to this mechanism.