Ectopic Liver Tissue on the Gallbladder

Cemil YÜKSEL; Yunus DÖNDER; Nihal Deniz BULUT YÜKSEL; Uğur İZOL

doi:10.14235/bas.galenos.2017.2023

ABSTRACT

Ectopic liver tissue is a rare developmental abnormality and is thought to be caused by aberrant migration in the embryological development of the liver. A 34-year-old female patient underwent laparoscopic cholecystectomy and ectopic liver tissue was found on the gallbaldder. Ectopic liver tissue was removed during cholecystectomy. Pathology was reported as normal liver tissue with the gallbladder tissue. Ectopic liver tissue is incidentally detected with no preoperative diagnosis. Ectopic liver tissue should be removed due to malignancy potential.

Keywords:

Laparoscopy, gallbladder, ectopic liver tissue

Introduction

Ectopic liver is a rare developmental abnormality and its incidence is 0.24%-0.48% (1). The first case was published in 1922. Ectopic liver is thought to develop due to aberrant migration occurred during embryological development (2). Although there are many different locations such as hepatic ligaments, falciform, omentum, diaphragm where it can locate; most oftenly it is located on the gallbladder (3). It can not be diagnosed by radiological imaging methodsand is usually seen during the operation. Although we have much knowledge about the ectopic liver the associated pathologies, treatment approaches, and complications should be known. Ectopic liver has been shown to have potential for hepatocellular cancer development (4). For this reason, removal of the ectopic liver is necessary. We present a patient in whom an ectopic liver on the gallbladder was detected during laparoscopic cholecystectomy performed due to cholelithiasis.

Discussion

The ectopic liver can be found in the abdomen or in the thorax, but most commonly on the gallbladder. The incidence is between 0.24% and 0.48% (1). Hepatobiliary system originates from foregut at the 4^th week of embryological development. Development of ectopic liver is thought to be caused by aberrant migration during the embryological development of the liver (2). Ectopic liver is frequently encountered incidentally during surgery (5). Patients often do not have symptoms. Symptoms may be due to torsion, necrosis, compression, or malignant transformation. However, it may cause cholelithiasis and cholecystitis (6). Ectopic liver may rarely be associated with some abnormalities. Ectopic liver can be seen rarely with cardiac abnormalities, biliary atresia, omphalocele and biliary duct cysts (7).

Ectopic liver tissue is generally not diagnosed, preoperatively. By ultrasound imaging, ectopic liver on the gallbladder can be seen and can be diagnosed with biopsy but biopsy should notbe done due to risk of bleeding and malignant spread.

In general, the pathology is reported as normal liver histology. Sometimes bile or portal vascular system may not develop. Although not fully proven, several publications have shown that ectopic liver increases the risk of hepatocellular cancer. This is thought to be caused by insufficient bile drainage and low arterial feeding (8).

Ectopic liver tissue should be removed because of the risk of malignancy. Ectopic liver tissue on the gallbladder should be resected together with the gallbladder. The vascular component of ectopic liver tissue is not seen, oftenly. If the liver has a vascular component, it is necessary to dissect the vascular component before separating the gallbladder from the liver bed. In this way, unwanted bleeding can be avoided.

As a result, ectopic liver is very rare and it is incidentally seen during surgery. It is most commonly found on the gallbladder. Ectopic liver is removed when it is seen because of risk of hemorrhage, pressure, rupture, necrosis and hepatic cancer.

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