Intermittent dislocation of the liver. A syndrome associated with volvulus of the transverse colon and stomach and obstructive jaundice

T. Miller and N. W. Thompson

Displacement of the right lobe of the liver into the left upper abdominal quadrant can occur only if the diaphragmatic attachments are congenitally absent or traumatically disrupted. To our knowledge, the former situation has not been previously described in an adult patient. A young man with a lifelong history of unexplained intermittent, bizarre upper abdominal pain was found to have a freely movable right lobe of the liver that was attached only to the inferior vena cava. When this lobe was intermittently displaced into the left upper abdomen, volvuli of both the stomach and transverse colon developed. Stretching and tension of the common bile duct on the round ligament resulted in intermittent jaundice. At operation, these findings were confirmed, and the right liver lobe was secured to the diaphragm in its normal position. In addition, the mesenteric attachments of the liver, stomach, and colon were plicated. The patient has had complete relief of all symptoms for the two years since his operation.