Accessory liver in an infant with congenital diaphragmatic hernia

Biliary Atresia: A Complex Hepatobiliary Disease with Variable Gene Involvement, Diagnostic Procedures, and Prognosis

The diagnosis of biliary atresia is still terrifying at the 3rd decade of the 21st century. In a department of neonatal intensive care unit, parents and physicians face a challenge with a jaundiced baby, who may or may not have a surgically correctable hepatopathy. The approach has been systematically evaluated, but the etiology remains ambiguous. The study of families with recurrent biliary atresia has been undertaken at a molecular level. The primary interest with this disease is to identify the etiology and change the treatment from symptomatic to curative. The occurrence of this obstructive cholangio-hepatopathy in well-known genetic syndromes has suggested just coincidental finding, but the reality can be more intriguing because some of these diseases may have some interaction with the development of the intrahepatic biliary system. Several genes have been investigated thoroughly, including ADD3 and GPC1 shifting the interest from viruses to genetics. In this review, the intriguing complexities of this hepatobiliary disease are highlighted.

Liver heterotopia associated with congenital diaphragmatic hernia: Two case reports and a review of the literature

RATIONALE

Liver heterotopia associated with congenital diaphragmatic hernia (CDH) is a rare condition; to the best of our knowledge, only 17 cases have been reported to date. The histogenesis and clinicopathological features are largely unknown. We herein report 2 cases of liver heterotopia associated with CDH along with 17 cases described in the literature to shed light on their clinicopathological characteristics.

PATIENT CONCERNS

Case 1 was a vaginally delivered male newborn who presented with respiratory distress immediately after birth. Case 2 was a female fetus who was found to have left-sided CDH during gestation.

DIAGNOSIS

In case 1, a chest X-ray revealed left-sided CDH. In case 2, magnetic resonance imaging performed at 33 weeks of gestation revealed left-sided CDH.

INTERVENTIONS

Case 1 underwent diaphragmatic patch repair surgery 3 days after birth. Histopathological examination following surgery in case 1 revealed the presence of ectopic liver tissue in the hernia sac. Case 2 was delivered by Cesarean section, and diaphragmatic patch surgery was performed 3 days after birth. During surgery, an isolated nodule was identified on the peritoneal side of the border of the defective foramen of the diaphragm. Histopathological examination following surgery in case 2 confirmed the presence of an epidermal cyst in the hernia sac. In addition, the isolated nodule was histopathologically found to be ectopic liver tissue.

OUTCOMES

In Case 1, CDH recurred at 6 months after surgery, and a second patch repair surgery was performed. The surgically removed hernia sac was found to contain microscopic ectopic liver tissue on histopathology. Case 1 recovered well after surgery, and there was no critical change during the 10-month postoperative period. Case 2 recovered well after surgery, and there was no critical change during the 20-month postoperative period.

LESSONS

There were no secondary pathological conditions associated with the presence of ectopic liver in CDH, such as torsion, infarction, rupture, intra-abdominal bleeding, or tumorization. Our observations suggest that liver heterotopia is a rare but asymptomatic condition in patients with CDH.

Intrathoracic caudate lobe of the liver: A case report and literature review

Heterotopic supradiaphragmatic livers are rare. A total of 23 cases of primary supradiaphragmatic livers have been reported in the literature. The clinical presentations of heterotopic supradiaphragmatic liver are variable. The simultaneous detection of intrathoracic accessory liver and pulmonary sequestration is extremely rare, and only one case has previously been reported. It is difficult to make a correct diagnosis preoperatively. We presented a 53-year-old woman with complaints of an intermittent, productive cough and dyspnea for two months that was refractory to medical treatment. She had no previous history of trauma or surgery. A chest radiograph only showed a widening of the mediastinum. Contrast-enhanced computed tomography of the chest revealed a well-circumscribed homogenous soft-tissue mass, approximately 4.35 cm × 2.5 cm × 6.14 cm in size, protruding through the right diaphragmatic crura to the right pleural cavity, attached to the inferior vena cava, esophagus and liver. There was no conclusive diagnosis before surgery. After the operation, we discovered that this patient was the first case of a supradiaphragmatic heterotopic liver, which passed through the inferior vena cava foramen and was coincidentally combined with an intralobar pulmonary sequestration that was found intraoperatively. We discussed its successful management with surgical resection via a thoracic approach and reviewed the published literature.

Hepatic heterotopia in congenital diaphragmatic anomaly

An antenatally diagnosed case of a left congenital diaphragmatic hernia is reported. The diaphragmatic eventration hernia sac consisted of a sheet of ectopic liver tissue in continuity with a hypoplastic left lobe which formed the medial anterior and posterior walls of the hernia is presented. The operative management of this combination of defects has not previously been described in English literature. Embryological considerations, limitations of accurate preoperative diagnosis, technical challenge in the operative repair of the defect and need for drainage is discussed.

Thoracoscopic resection of an intrathoracic accessory liver lobe: an incidental finding in the workup of a child with a respiratory infection

A case of an intrathoracic accessory liver lobe in a five-year-old female is presented, representing an incidental finding during workup for a respiratory infection. MRI was used to identify what appeared to be an accessory intrathoracic liver lobe. Thoracoscopy confirmed the diagnosis, and removal was achieved through a minimally invasive surgical procedure. Based on an electronic literature search, this is the first known report of minimally invasive techniques to remove accessory liver from the chest in a pediatric patient.

Hepatic mesenchymal hamartoma in a neonate with a Bochdalek diaphragmatic hernia: a case report

The Bochdalek diaphragmatic hernia (BDH) is a common birth defect that is associated with other congenital malformations. Hepatic mesenchymal hamartoma (HMH) is the second most common benign hepatic tumor in children. The association between BDH and HMH or ectopic hepatic tissue is uncommon. We report a case of a female newborn with a left BDH that at surgery was incidentally found to have a tumor of 3.5 cm in maximum dimension with a serous muscular membrane. The histopathological study revealed vascular-mesenchymal stroma with bile ducts entrapped and peripheral normal hepatic tissue. These findings correlate with the diagnosis of hepatic mesenchymal hamartoma (HMH) in ectopic hepatic tissue. Our objective is to report a case of a rare association between HMH and BDH as well as discuss its differential diagnosis.

Left-sided congenital diaphragmatic hernia with multiple congenital cardiac anomalies, hernia sac, and microscopic hepatic heterotopia: a case report

Congenital diaphragmatic hernia is a common congenital anomaly of uncertain etiology. Its association with multiple congenital anomalies in various organs is well recognized and antenatal radiological evidence of congenital diaphragmatic hernia warrants thorough evaluation to detect other anomalies, some of which can be life threatening. Rarely, heterotopic hepatic tissue is identified in the hernia, a rare pathological finding, exhibiting more than one macroscopic and microscopic characteristics, and always associated with cardiac congenital anomalies. Herein, we report a case of left-sided microscopic heterotopic hepatic tissue in a congenital diaphragmatic hernia in an infant with multiple cardiac congenital anomalies, but with preserved pericardium.

Accessory lobe of right liver mimicking a pulmonary tumor in an adult male

We describe a rare case of ectopic liver tissue in the right thoracic cavity. A 39-year-old man with a suspected lung tumor underwent thoracotomy. The intraoperative finding revealed an accessory liver lobe connected to the right lobe of the liver by a small pedicle that pierced the diaphragm. A pathologic evaluation confirmed the specimen to be hepatic tissues. In retrospect, the correct diagnosis of accessory liver could have been achieved using appropriate radiologic investigations if this possibility had been considered.

Left congenital diaphragmatic hernia, absent pericardium, and liver heterotopia: a case report and review

A case of a left congenital diaphragmatic hernia (CDH), absent pericardium, and a hernial sac containing ectopic liver tissue is presented. This triplicate of defects is exceedingly rare with only 2 previous reports in the literature dating back to 1936. This case supports the evidence that CDH is the result of failure of the closure of the pleuroperitoneal canals by the growth of the posthepatic mesenchymal plate. Moreover, the role of the phrenic nerve as a mediator for both CDH and absent pericardium is discussed.

Right congenital diaphragmatic hernia associated with fusion of the liver and the lung

We present the case of a male infant at a gestational age of 41 weeks who presented with a right congenital diaphragmatic hernia. During surgical exploration, right hepatopulmonary fusion was encountered. We review the existing literature on this problem, describe a novel surgical approach, and review the embryology of this complex lesion.