Formation and rupture of liver hematomas caused by intrahepatic gallbladder perforation:A case report and review of literature

BACKGROUND Gallbladder perforation is a serious complication of acute cholecystitis.Such perforation is a rare but life-threatening situation that can lead to the formation and rupture of liver hematomas.Here,we report a case of a ruptured intrahepatic hematoma caused by intrahepatic gallbladder perforation,and we present a literature review.CASE SUMMARY A 70-year-old male was admitted to the hospital with a complaint of right upper quadrant abdominal pain,flustering and dizziness.The preoperative diagnosis was a ruptured malignant liver tumor,and the patient’s medical images and increased level of carbohydrate antigen-199 suggested that the gallbladder had been invaded.However,the tumor was proven to be a liver hematoma secondary to gallbladder perforation after surgery.The patient was discharged uneventfully on the fifteenth postoperative day.CONCLUSION Intrahepatic gallbladder perforation is difficult to diagnose preoperatively.Radiological examinations play a crucial role in the diagnosis but only for partial cases.Early diagnosis and appropriate surgery are key to managing this rare condition.

Radical cholecystectomy without liver resection for peritoneal side early incidental gallbladder cancer

Gallbladder cancer(GBC)is a rare disease with a poor prognosis.Simple cholecystectomy may be an adequate treatment only for very early disease(Tis,T1a),whereas reoperation is recommended for more advanced disease(T1b and T2).Radical cholecystectomy should have two fundamental objectives:To radically resect the liver parenchyma and to achieve adequate clearance of the lymph nodes.However,recent studies have shown that compared with lymph node dissection alone,liver resection does not improve survival outcomes.The oncological roles of lymphadenectomy and liver resection is distinct.Therefore,for patients with incidental GBC without liver invasion,hepatic resection is not always mandatory.

Clinical Observation on Modified Huan'gan Lipi Decoction Combined with Acupuncture in Treating Spleen Deficiency and Liver Hyperactivity Type Tic Disorders

[Objectives]To observe the clinical efficacy of Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type tic disorders(TD).[Methods]Sixty patients with spleen deficiency and liver hyperactivity type TD were randomly divided into a treatment group of 40 cases and a control group of 20 cases.The treatment group received Modified Huan'gan Lipi Decoction combined with acupuncture,and the control group received Haloperidol Tablets.After 4 weeks of treatment,the Yale Global Tic Severity Scale(YGTSS)score,the total score of TCM syndrome and the clinical efficacy were compared between the two groups before and after treatment.[Results]After treatment,the total effective rate of 87.5%in the treatment group was higher than 80.0%in the control group(P>0.05);the total score of YGTSS and the total score of TCM syndromes in the two groups were compared within groups,P﹤0.01;between groups,P﹤0.01.The recurrence rates of the treatment group and the control group were 11.1%and 71.4%,respectively.The difference between the two groups was statistically significant(P﹤0.01).[Conclusions]Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type TD can significantly improve the patient's tic symptoms,and its long-term efficacy is stable.

Metastasis of primary gallbladder carcinoma in lymph node and liver

AIM: To evaluate the patterns with metastasis of gallbladder carcinoma in lymph nodes and liver. METHODS: A total of 45 patients who had radical surgery were selected. The patterns with metastasis of primary gallbladder carcinoma in lymph nodes and liver were examined histopathologically and classified as TNM staging of the American Joint Committee on Cancer. RESULTS: Of the 45 patients, 29 (64.4%) had a lymph node positive disease and 20 (44.4%) had a direct invasion of the liver. The frequency of involvement of lymph nodes was strongly influenced by the depth of the primary tumor (P= 0.0001). The postoperative survival rate of patients with negative lymph node metastasis was significantly higher than that of patients with positive lymph node metastasis (P= 0.004), but the postoperative survival rate of patients with Nl lymph node metastasis was not significantly different from that of patients with N2 lymph node metastasis (P= 0.3874). The postoperative survival rate of patients without hepatic invasion was significantly better than that of patients with hepatic invasion (P= 0.0177). CONCLUSION: Complete resection of the regional lymph nodes is important in advanced primary gallbladder carcinoma (PGC). The initial sites of liver spread are located mostly in segments IV and V. It is necessary to achieve negative surgical margins 2 cm from the tumor. In patients with hepatic hilum invasion, extended right hepatectomy with or without bile duct resection or portal vein resection is necessary for curative resection.

PRIMARY NEUROENDOCRINE TUMORS OF THE LIVER AND GALLBLADDER

To study Clinico-pathological characters of the neuroendocrine tumors of the liver and gallbladder.MethodsUsing histology, immunohistochemistry and electron microscope, 3 cases of liver and gallbladder were investigated. The primary antibodies including anti-chromogranin A, gastrin, serotonin, insulin, somatostatin, gastrin, pancreatic polypeptide, adreno- corticotropic hormone (ACTH), calcitonin, bombesin, β-human chorionic gonadotropin (β-HCG) were employed to identify the property of tumors.ResultsIn one cases tumor of neuroendocrine carcinoma. In the other two cases tumor were typical carcinoid. In immunohistochemistry study, the tumor cells showed positive reaction to chromagranin A and contained positive cells of gastrin, serotonin, insulin and pancreatic polypaptide. Electronmicroscopy showed the cytoplasm contained dense round granules.ConclusionThe Nuroendocrine tumor of liver and gallbladder is a special type neoplasm with character of histology, immunohistochemistry and electron microscopy. Subject headings neuroendocrine tumor gallbladder liver immunohistochemistry and electron microscopy.

STUDY ON THE ATTACK CONTROL ACTION OF ELECTRO-ACUPUNC-TURE ON T■IYANG(太阳EX-HN5)FOR MIGRAINE DUE TO HYPERAC-TIVITY OF LIVER YANG:RANDOMIED CONTROLED TRIAL

Objective To discuss the difference of electro-acupuncture and drug in controlling the attack of migraine due to hyperactivity of liver yang. Methods Three-centered random control method was used, and 300 qualified cases were randomly divided into treatment group （146 cases according to the design） and control group （140 cases）, which were respectively treated with electro-acupuncture and drugs （Compound Aminopyrine Phenacetin Tablets, Ergotamine Caffeine Tablets, Diazepam Tablets）, and observed the overall effect and scores of headache, accompanying symptoms, psychological and social adaptability scores, life quality scores, TCM symptoms scores and follow-up results before and after the treatment. Results In treatment group, the successful rate of attack control was 47.3 %, the improvement rate was 73.3 %, and the total effectiveness was 90.4 %, the clinical control rate and improvement were much superior to control group （the clinical control rate 35.7 %, improvement 61.4 %, the total effectiveness 85. 7 % ）, P〈0. 01, the difference in effect was mainly reflected in patients with moderate severity; the total scores of TCM syndrome after the treatment was obviously significant or very obviously significant（ P〈0. 05, P〈0. 01 ）, but the headache scores between two groups was not obviously significant（P〉0.05）, the difference in accompanying symptoms was significant（ P〈0. 01 ） ;the long term attack control action in two groups was not satisfactory, the recurrence was similar （P〉0. 05） ,the severity of headache in recurrence cases of treatment group was alleviated and superior to control group（ P 〈 0. 01 ）, the occurrence of headache after the treatment is much less than that before the treatment and the situation after 2 months was superior to control group （P〈0. 01 ）. Sleepiness and redness of face in some patients which were seen in control group weren＇t seen in treatment group. Conclusion Electro-acupuncture on Tàiyáng （太阳 EX-HN5） can control the attack of migraine due to hyperactivity of liver yang, and it has advantages in improving the accompanying symptoms and reducing the toxic and side effects of western drugs.

Proteomic analysis of effects of Chinese herbs to calm the liver and suppress hyperactive yang in a rat migraine model

BACKGROUND： The expression of ubiquitin and energy-associated protein can provoke migraines. Studies have suggested that expression is closely linked to ＂hyperactivity of liver-yang theory＂ in Traditional Chinese Medicine （TCM）, as well as the function of periphery sympathetic nerve medulla. OBJECTIVE： To observe proteomic changes in a rat migraine model with regard to hyperactivity of liver-yang when treated with Chinese herbs to calm the liver and suppress hyperactive yang compound. DESIGN, TIME AND SETTING： A randomized controlled study. This study was performed at the laboratory of Institute of Integrated Traditional Chinese and Western Medicine, Institute of Human Reproduction and Stem Cell Engineering and Key Laboratory of Cancer Proteomics of Ministry of Health, Xiangya Hospital Affiliated to Central South University between September 2006 and July 2007. MATERIALS： Thirty, male, healthy, Sprague-Dawley rats, aged eight weeks, were included in the final analysis. Aconite, to calm the liver and suppress hyperactive yang compound, was provided by the Dispensary of Traditional Chinese medicine, Xiangya Hospital, Central South University. A physiological electronic stimulator, type SDQ-1, was provided by Bengbu Practical Institute of Technology. The left trigeminal ganglion was localized and stimulated for 10 minutes, and the rats were orally administered an aconite concoction to establish a rat migraine model with hyperactivity of liver-yang. METHODS： Rats were randomly divided into a normal control group, model group, and TCM treatment group, with 10 rats in each group. The TCM treatment group was orally treated to calm the liver and suppress the hyperactive yang compound once a day for 28 days. In contrast, the model group and normal group were orally administered the same amount of distilled water once a day for 28 days. MAIN OUTCOME MEASURES： The total proteins from adrenal glands of the three groups were separated by two-dimensional gel electrophoresis （2-DE）, and 2-DE images were analyzed by PDQuest 7.0 software. Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry （MALDI-TOF-MS） was used to obtain peptide mass fingerprints of the differential proteins. Databases were searched to identify the proteins, RESULTS： A total of 30 rats were included in the final analysis. Reproducible 2-DE patterns from rat adrenal gland of the three groups were obtained. Compared with the normal group, nine proteins were down-regulated and five proteins were up-regulated in the model group; however, these expressions returned to normal, or near normal levels, in the TCM treatment group. A total of eight differentially expressed proteins were identified： glycogen phosphorylase, ATP synthase D chain, isovaleryl-CoA dehydrogenase, ubiquitin, Annexin-3, Annexin-A1, Peroxirdoxin-II, and heat shock protein-27. CONCLUSION： Liver calming and suppression of the hyperactive yang compound may up-regulate expression of proteins related to energy metabolism and the ubiquitin system. Compounds that are used to treat migraines may contribute to protein functions in the peripheral sympathetic nervous system.

Gallbladder polyp as a manifestation of hemobilia caused by arterial-portal fistula after percutaneous liver biopsy: A case report

Outpatient percutaneous liver biopsy is a common practice in the differential diagnosis and treatment of chronic liver disease. The major complication and mortality rate were about 2-4% and 0.01-0.33% respectively. Arterio-portal fistula as a complication of percutaneous liver biopsy was infrequently seen and normally asymptomatic. Hemobilia, which accounted for about 3% of overall major percutaneous liver biopsy complications, resulted rarely from arterio-portal fistula We report a hemobilia case of 68 years old woman who was admitted for abdominal pain after liver biopsy. The initial ultrasonography revealed a gallbladder polypoid tumor and common bile duct (CBD) dilatation. Blood clot was extracted as endoscopic retrograde cholangiopancreatography (ERCP) showed hemobilia. The patient was shortly readmitted because of recurrence of symptoms. A celiac angiography showed an intrahepatic arterio-portal fistula. After superselective embolization of the feeding artery, the patient was discharged uneventfully. Most cases of hemobilia caused by percutaneous liver biopsy resolved spontaneously. Selective angiography embolization or surgical intervention is reserved for patients who failed to respond to conservative treatment.

Hepatectomy for gallbladder-cancer with unclassified anomaly of right-sided ligamentum teres: A case report and review of the literature

Right-sided ligamentum teres(RSLT) is a congenital anomaly in which the right umbilical ligament becomes dominant and anomalous ramifications of the hepatic vessels and biliary system are present. A male patient in his 70 s was diagnosed with advanced gallbladder cancer directly infiltrating the right hepatic duct(RHD), together with RSLT. Preoperative three-dimensional simulation of the liver based on multiple detector computed tomography images after cholangiography revealed ramifications of all segmental portal veins from the portal trunk and discordance of the arterial and biliary branching patterns of segment 8. Fusion analysis of the biliary architecture and segmental volumetry showed that the RHD drained segments 1 r, 5, 6, and 7. We successfully performed a modified right-sided hepatectomy sparing segment 8(i.e., resection of the RHD drainage territory), with negative surgical margins. This report is the first to describe major hepatectomy for advanced gallbladder cancer with RSLT.

Clinical observation of gastrointestinal function recovery in patients after hepatobiliary surgery

BACKGROUND The liver is an important metabolic and digestive organ in the human body,ca-pable of producing bile,clotting factors,and vitamins.AIM To investigate the recovery of gastrointestinal function in patients after hepato-biliary surgery and identify effective rehabilitation measures.METHODS A total of 200 patients who underwent hepatobiliary surgery in our hospital in 2022 were selected as the study subjects.They were divided into a control group and a study group based on the extent of the surgery,with 100 patients in each group.The control group received routine treatment,while the study group re-ceived targeted interventions,including early enteral nutrition support,drinking water before gas discharge,and large bowel enema,to promote postoperative gastrointestinal function recovery.The recovery of gastrointestinal function was compared between the two groups.RESULTS Compared with the control group,patients in the study group had better recovery of bowel sounds and less accumulation of fluids in the liver bed and gallbladder fossa(P<0.05).They also had shorter time to gas discharge and first meal(P<0.05),higher overall effective rate of gastrointestinal function recovery(P<0.05),and lower incidence of postoperative complications(P<0.05).CONCLUSION Targeted nursing interventions(early nutritional support,drinking water before gas discharge,and enema)can effectively promote gastrointestinal function recovery in patients undergoing hepatobiliary surgery and reduce the incidence of complications,which is worthy of promotion.

Sinistroposition of the gallbladder and common bile duct

BACKGROUND: Despite its rare incidence, few cases of left-side gallbladder have been already published. METHODS: We reported herein the case of a 29-year-old man with a left liver tumor in whom left lateral bisegmen- tectomy was mandatory. It represents the first description of a sinistroposition of both gallbladder and common bile duct. RESULTS: Surgical exploration revealed a left-side gall- bladder , located under the left lobe of the liver. During he- patic parenchyma dissection at the left side of the round liga- ment and the Rex recessus, the common bile duct was in- jured. Complete separation of hepatic pedicle structures showed that the upper biliary convergence passed on the left side of the Rex recessus before reaching the hepatoduo- denal ligament. CONCLUSION: Only careful dissection of the hepatoduo- denal ligament up to Rex recessus level prior to liver paren- chyma resection could avoid biliary tract injury during left lobectomy.

Stepwise evaluation of liver sectors and liver segments by endoscopic ultrasound

The liver has eight segments, which are referred to by numbers or by names. The numbering of the segments is done in a counterclockwise manner with the liver being viewed from the inferior surface, starting from Segment Ⅰ(the caudate lobe). Standard anatomical description of the liver segments is available by computed tomographic scan and ultrasonography. Endoscopic ultrasound(EUS) has been used for a detailed imaging of many intra-abdominal organs and for the assessment of intra-abdominal vasculature. A stepwise evaluation of the liver segments by EUS has not been described. In this article, we have described a stepwise evaluation of the liver segments by EUS. This information can be useful for planning successful radical surgeries, preparing for biopsy, portal vein embolization, transjugular intrahepatic portosystemic shunt, tumour resection or partial hepatectomy, and for planning EUS guided diagnostic and therapeutic procedures.

Primary liposarcoma of gallbladder diagnosed by preoperative imagings: A case report and review of literature

A 49-year-old Japanese woman was referred to our department because of high fever and a huge abdominal mass. Computed tomography （CT） and magnetic resonance （MR） imagings revealed a tumor, about 30 cm in diameter, occupied the right hepatic lobe and the peritoneal cavity. Abdominal angiography showed that the tumor was fed mainly by the cystic artery. We preoperatively diagnosed angiosarcoma of the gallbladder and performed tumor resection with cholecystectomy because the tumor was almost casplated, however the posterior wall of the gallbladder attached to the tumor firmly. Histologically, the tumor was composed of spindle cells including lipoblasts with cellular pleomorphism, which were also detected in the muscular layer of the gallbladder. We finally diagnosed pleomorphic liposarcoma of the gallbladder. At 10 mo and 29 mo after the first operation, she underwent two more operations because of recurrence. Now she has a good quality of life 3 years and 6 mo after the first operation.

Impact of nonalcoholic fatty liver disease on the risk of gallbladder polyps in lean and non-obese individuals:A cohort study

Background:The association between non-obese or lean nonalcoholic fatty liver disease(NAFLD)and gallbladder polyps(GBPs)has not yet been evaluated.We aimed to determine whether NAFLD is an independent risk factor for the development of GBPs,even in non-obese and lean individuals.Methods:We analyzed a cohort of 331208 asymptomatic adults who underwent abdominal ultrasonography(US).The risk of GBP development was evaluated according to the obesity and NAFLD status.Results:The overall prevalence of NAFLD and GBPs≥5 mm was 28.5%and 2.9%,respectively.The prevalence of NAFLD among 160276 lean,77676 overweight and 93256 obese participants was 8.2%,31.2%,and 61.1%,respectively.Individuals with NAFLD had a significantly higher incidence of GBPs with a size of≥5 mm[adjusted odds ratio(OR)=1.18;95%confidence interval(CI):1.11–1.25].A higher body mass index and its categories were also significantly associated with an increased risk of GBPs≥5 mm.Moreover,risk of GBPs≥5 mm was significantly increased even in NAFLD individuals who are not obese(lean:adjusted OR=1.36,95%CI:1.19-1.54;overweight:adjusted OR=1.14,95%CI:1.03–1.26,respectively).Conclusions:Non-obese/lean NAFLD is an independent risk factor for GBP development,suggesting that NAFLD may play an important role in the pathogenesis of GBPs regardless of the obesity status.Therefore,a more thorough evaluation for GBPs may be necessary when hepatic steatosis is detected on abdominal US,even in non-obese or lean individuals.

Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy

Even after extensive preoperative assessment,staging laparoscopy may allow avoidance of non-therapeutic laparotomy in patients with radiographically occult metastatic or locally unresectable disease.Staging laparoscopy is associated with decreased postoperative pain,a shorter hospital stay and a higher likelihood of receiving systemic therapy compared to laparotomy but its yield has decreased with improvements in imaging techniques.Current uses of staging laparoscopy include the following:(1) In the staging of pancreatic adenocarcinoma,laparoscopic staging allows for the identif ication of sub-radiographic metastatic disease in locally advanced cancer in approximately 30% of patients and,in radiographically resectable cancer,may identify metastatic disease in 10%-15% of cases;(2) In colorectal liver metastases,selective use of laparoscopic staging in patients with a clinical risk score of over 2 identifies unresectable disease in approximately 20% of patients;(3) In hepatocellular carcinoma,laparoscopic staging could be selectively used in high-risk patients such as those with clinically apparent liver cirrhosis and in patients with major vascular invasion or bilobar tumors;and(4) In biliary tract malignancy,staging laparoscopy may be used in all patients with potentially resectable primary gallbladder cancer and in selected patients with T2/T3 hilar cholangiocarcinoma.Because of the decreasing yield of SL secondary to improvements in imaging techniques,staging laparoscopy should be used selectively for patients with pancreatic and hepatobiliary malignancy to avoid unnecessary non-therapeutic laparotomy and to improve resource utilization.Each individual surgeon should apply his or her threshold as to whether staging laparoscopy is indicated according to the quality of preoperative imaging studies and the availability of resources at their own institution.

Unexpected gallbladder cancer:Surgical strategies and prognostic factors

Gallbladder cancer is the most common tumor of the biliary tract and it is associated with a poor prognosis.Unexpected gallbladder cancer is a cancer incidentally discovered,as a surprise,at the histological examination after cholecystectomy for gallstones or other indications.It is a potentially curable disease,with an intermediate or good prognosis in most cases.An adequate surgical strategy is mandatory to improve the prognosis and an adjunctive radical resection may be required depending on the depth of invasion.If the cancer discovered after cholecystectomy is a pTis or a pT1a,a second surgical procedure is not mandatory.In the other cases(pT1b,pT2 and pT3 cancer) a re-resection(4b + 5 liver segmentectomy,lymphadenectomy and port-sites excision in some cases) is required to obtain a radical excision of the tumor and an accurate disease staging.The operative specimens of re-resection should be examined by the pathologist to find any "residual" tumor.The "residual disease" is the most important prognostic factor,significantly reducing median disease-free survival and disease-specific survival.The other factors include depth of parietal invasion,metastatic nodal disease,surgical margin status,cholecystectomy for acute cholecystitis,histological differentiation,lymphatic,vascular and perineural invasion and overall TNM-stage.

Fatty liver is an independent risk factor for gallbladder polyps

BACKGROUND Gallbladder polyps(GBPs)are known to be associated with obesity and metabolic diseases.However,to date,the relationship between GBPs and abnormal body fat distribution,such as fatty liver,visceral obesity,or sarcopenia,has not yet been established.AIM To evaluate whether GBPs are associated with fatty liver,visceral obesity,or sarcopenia.METHODS We retrospectively reviewed the medical records of subjects who underwent various laboratory tests,body composition measurement with a non-invasive body composition analyzer,and abdominal ultrasonography during health checkups.A total of 1405 subjects with GBPs were compared with 2810 age-and sex-matched controls.RESULTS The mean age of the subjects was 46.8±11.7 years,and 63.8%were male.According to multiple logistic regression analysis,the presence of fatty liver[odds ratio(OR)1.413;95%confidence interval(CI)1.218-1.638;P<0.001]was an independent risk factor for GBP,together with low levels of alanine aminotransferase(OR 0.993;95%CI 0.989-0.996;P<0.001).Additionally,fatty liver showed both independent(OR 1.629;95%CI,1.335-1.988;P<0.001)and dosedependent(moderate to severe fatty liver;OR 2.137;95%CI,1.662-2.749;P<0.001)relationship with large GBPs(≥5 mm).The presence of sarcopenia and high visceral fat area were not significantly associated with GBPs.CONCLUSION Fatty liver was found to be closely associated with GBPs irrespective of sarcopenia and visceral obesity.

Pathogenesis and clinical spectrum of primary sclerosing cholangitis

Primary sclerosing cholangitis(PSC) is a disease of the biliary tract, which has been documented in the literature since 1867. This disease has a strong predilection for affecting men and can be seen in individuals as young as 2 years of age. PSC has a strong associated with inflammatory bowel disease, more commonly with ulcerative colitis, and is also part of the clinical spectrum of Ig G4-related diseases. Smallduct PSC, a variant of PSC, also has an association with inflammatory bowel disease. The exact pathogenesis of PSC is not well understood at present, however, is likely a combination of a genetic predisposition with alteration of the molecular structure of the gut. Abnormal serum liver chemistry and presence of certain autoimmune markers are usually the first indicators leading to a diagnosis of PCS, however, these may often be normal in early stages of this disease. The diagnosis is made by cholangiography, which is now considered the gold standard. PSC is a known pre-malignant condition. Such patients have an increased risk of developing cholangiocarcinoma, gallbladder neoplasia, and colon cancer. Many new treatment modalities have emerged in the recent past, including anti-tumor necrosis factor-α and anti-integrins; however, liver transplantation is the only known cure for PSC. Despite past and present research, PSC remains an enigmatic biliary disease with few viable treatment options.

HER2 aberrations and heterogeneity in cancers of the digestive system: Implications for pathologists and gastroenterologists

Management of cancers of the digestive system has progressed rapidly into the molecular era. Despite the significant recent achievements in the diagnosis and treatment of these patients, the number of deaths for these tumors has currently plateaued. Many investigations have assessed the role of HER2 in tumors of the digestive system in both prognostic and therapeutic settings, with heterogeneous results. Novel testing and treatment guidelines are emerging, in particular in gastric and colorectal cancers. However, further advances are needed. In this review we provide a comprehensive overview of the current state-ofknowledge of HER2 alterations in the most common tumors of the digestive system and discuss the operational implications of HER2 testing.

Ectopic liver tissue (choristoma) on the gallbladder: Acomprehensive literature review

BACKGROUND Liver tissue situated outside the liver with a hepatic connection is usually calledan accessory liver, and that without a connection to the mother liver, is calledectopic liver tissue.AIM To identify studies in the literature on ectopic liver tissue located on thegallbladder surface or mesentery.METHODS We present two patients and review published articles on ectopic liver tissuelocated on the gallbladder surface accessed via PubMed, MEDLINE, GoogleScholar, and Google databases. Keywords used included accessory liver lobe,aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic livertissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopicliver tissue on the gallbladder. The search included articles published before June2020 with no language restriction. Letters to the editor, case reports, reviewarticles, original articles, and meeting presentations were included in the search.Articles or abstracts containing adequate information on age, sex, history of liverdisease, preliminary diagnosis, radiologic tools, lesion size, surgical indication,surgical procedure, and histopathological features of ectopic liver tissue wereincluded in the study.RESULTS A total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 werefemale and 25 were male (no gender available for 4 patients), and the age rangewas 5 d to 91 years. Forty-nine patients underwent surgery for chroniccholecystitis or cholelithiasis, and 14 patients underwent surgery for acutecholecystitis. The remaining 28 patients underwent laparotomy for other reasons.Cholecystectomy was laparoscopic in 69 patients and open in 11 patients. Theremaining 19 patients underwent various other surgical procedures such asautopsy, liver transplantation, living donor hepatectomy, Whipple procedure, andliver segment V resection. Histopathologically, hepatocellular carcinoma wasdetected in the ectopic liver tissue of one patient.CONCLUSION Ectopic liver tissue is a rare developmental anomaly which is usually detectedincidentally. Although most studies suggest that ectopic liver located outside thegallbladder has a high risk of hepatocellular carcinoma, this is not reflected instatistical analysis.