[The torsion of an accessory liver lobe as the rare cause of acute abdomen].

HISTORY AND CLINICAL FINDINGS

A 35-year-old woman was admitted because of cramp-like abdominal pain with nausea and vomiting since the previous evening. There was no history of previous abdominal symptoms of jaundice. Physical examination suggested atypical appendicitis with pain on palpation of the right mid-abdomen, localized paraumbilical guarding tension and diffuse pressure pain, more on the right, on rectal examination. Body temperature was 37.8 degrees C.

EXAMINATIONS

There were leucocytosis (12000/microliters) and abnormally high liver function tests (GOT 95 U/l, GPT 110 U/l, LDH 368 U/l, alkaline phosphatase 335 U/l). Ultrasonography of the abdomen demonstrated free fluid in the Douglas pouch.

TREATMENT AND COURSE

Laparotomy, performed because atypical appendicitis was suspected, revealed a torsioned pedicle of a severely bleeding accessory liver lobe positioned near the gall bladder bed. The accessory lobe was removed and the patient became symptom-free. This is the 15th reported case of clinical manifestations of an accessory liver lobe.