Statistics from Altmetric.com
A 40-year-old man with a history of cerebral palsy presented to the emergency department with recurrent episodes of vomiting. He had several similar presentations requiring hospital admission over the past 3 years. In 2017, he was admitted for a similar presentation, and CT radiograph demonstrated intestinal obstruction at the proximal jejunal region. He underwent a diagnostic laparoscopy, and a paraduodenal hernia was found. A laparoscopic repair was performed, his symptoms resolved for a short period of time.
However, after 3 months, his symptoms reoccurred and during multiple presentations a number of CT radiographs were performed. Each CT showed the position of his liver in different locations (figure 1), confirming the diagnosis of a wandering liver.
Extrinsic compression of duodenum secondary to the wandering liver was suspected. An upper gastrointestinal gastrograffin fluoroscopy with dynamic positioning of the patient was performed. An ultrasound was also performed during the gastrograffin fluoroscopy study to confirm the position of liver during positioning.
When the patient was in right decubitus position, an ultrasound was performed to confirm that the liver was on the right of midline. Contrast was then administered via a nasogastric (NG) tube. The study demonstrated brisk transit. The patient was subsequently repositioned in left decubitus position, and further contrast was administered. This study showed delay in gastric emptying as evidenced by pooling of contrast material in gastric antrum due to extrinsic compression from a wandering liver (figure 2).
The patient’s symptoms improved with gastric decompression via NG tube. Oral nutrition was well tolerated, and the patient was discharged home shortly afterwards.
Wandering liver or hepatic vagrancy is a rare condition—only 25 reported cases since 1890.1–3
Most reported cases were associated with colonic, predominantly sigmoid, obstruction or volvulus.4
Due to its rarity and non-specific presentation, diagnosis and management of wandering liver remained challenging.2 3 5 6 However, there were two general approaches in treating patients with wandering liver:
Contributors PSB, JF and AB treated the patient. MS was consulted for hepatobiliary surgery opinion.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Obtained.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.