Accessory Hepatic Lobe Strangulated in Post-traumatic Diaphragmatic Hernia

Abstract

The accessory lobe of the liver is a rare morphological variation. It is frequently found in the lower segments. Riedel's lobe is the best known of the accessory lobes of the liver and corresponds to an enlargement of segments V and VI with an incidence of 3.3% to 14.5%. It is often diagnosed incidentally and sometimes revealed by a complication, the association of a strangulated post-traumatic diaphragmatic hernia containing the Riedel's lobe is an unusual situation. The present study report the first case of this association in a patient, admitted in emergency after a violent closed thoraco-abdominal trauma following a public road accident four days earlier. The physical examination was poor and the symptoms were non-specific. The diagnosis was made by preoperative imaging, the chest X-ray found the digestive gas into the thoracic cavity, the thorax and abdominal CT scan showed a solution of continuity of the right anteromedial part of the diaphragm through which protrudes in the intrathoracic the segment of the liver with parenchyma perfusion disorders and a dilated colonic segment in the right hemi thoracic cavity without signs of pneumatosis. There was a repression of the mediastinum organs to the left thoracic cavity. The surgical treatment consisted in a reduction of the hernia content, which was viable with the diaphragmatic defect closure with non absorbable interrupted suture. The post operative was uneventfull. The aim of this study is to show the possibility of this association which must be kept in mind in case of violent closed thoraco-abdominal trauma or basithoracic injury.