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一例罕见病例报告:胆囊相关异位肝组织:挑战、见解及手术考量

A rare case report: Gallbladder-associated ectopic liver tissue: Challenges, insights, and surgical considerations.

作者信息

Ferjaoui Wael, Omry Ahmed, Changuel Amel, Mejri Khouloud, Mannai Med Hedi, Khalifa Med Bachir

机构信息

General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia.

Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia.

出版信息

Int J Surg Case Rep. 2024 Feb;115:109261. doi: 10.1016/j.ijscr.2024.109261. Epub 2024 Jan 12.

Abstract

INTRODUCTION AND IMPORTANCE

Ectopic liver tissue (ELT), a rare anomaly distinct from accessory liver, challenges conventional embryonic morphogenesis. Unlike the latter, ELT lacks a connection to the main liver, showcasing an unusual growth of normal liver tissue beyond its customary location. This peculiarity poses clinical and radiological challenges for surgeons throughout their careers, particularly during laparoscopic or open procedures. Elevated clinical significance arises from ELT's potential to progress into hepatocellular carcinoma, necessitating heightened awareness among surgeons.

CASE REPORT

This article presents a compelling case of ELT, discovered incidentally during a planned laparoscopic cholecystectomy. The patient, a 60-year-old female with a history of biliary colic, underwent a meticulous exploration revealing an undistended gallbladder with an unexpected brownish tissue fragment resembling hepatic parenchyma.

CLINICAL DISCUSSION

Ectopic liver tissue, dating back to early 20th-century records, challenges precise incidence determination. Theories regarding embryonic development around the fourth week in utero provide insights into ELT's origins and displacement from the hepatic diverticulum. Varied attachment locations and potential manifestations in other intra-abdominal and intra-thoracic sites add layers to the complexity of its diagnosis. Radiological studies, though challenging, offer glimpses of ELT, cautioning against percutaneous biopsies due to associated risks.

CONCLUSION

In conclusion, this case of ELT offers valuable insights into its diagnostic challenges and surgical considerations, underscoring the need for continued research and heightened awareness in the medical community. The rarity and varied presentations of ELT warrant ongoing exploration to refine diagnostic approaches and optimize patient outcomes.

摘要

引言与重要性

异位肝组织(ELT)是一种与副肝不同的罕见异常,对传统胚胎形态发生学提出了挑战。与副肝不同,ELT与主肝无连接,显示出正常肝组织在其通常位置之外的异常生长。这种特殊性在外科医生的整个职业生涯中都带来了临床和放射学挑战,尤其是在腹腔镜或开放手术过程中。ELT有可能发展为肝细胞癌,这使其临床意义更为突出,外科医生必须提高对此的认识。

病例报告

本文介绍了一例引人关注的ELT病例,该病例在计划进行的腹腔镜胆囊切除术中偶然发现。患者为一名60岁女性,有胆绞痛病史,经过细致探查发现胆囊未扩张,但有一个意外的褐色组织碎片,类似肝实质。

临床讨论

异位肝组织可追溯到20世纪早期的记录,其精确发病率难以确定。关于子宫内第四周左右胚胎发育的理论为ELT的起源和从肝憩室的移位提供了见解。其在其他腹腔内和胸腔内部位的不同附着位置和潜在表现增加了诊断的复杂性。放射学检查虽然具有挑战性,但能提供ELT的一些线索,由于存在相关风险,应谨慎进行经皮活检。

结论

总之,该ELT病例为其诊断挑战和手术考量提供了有价值的见解,强调了在医学界持续研究和提高认识的必要性。ELT的罕见性和多样表现需要持续探索,以完善诊断方法并优化患者预后。

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