Hepatic torsion and dislocation with hypotension and colonic obstruction

A case of hepatic torsion is presented with the following clinical features: 1) complete dislocation of the liver into the left upper quadrant, 2) 180 degrees clockwise torsion of the liver with severe ischemia, 3) hypotension secondary to vena caval obstruction, 4) ascites, 5) congenital absence of falciform and triangular ligaments, 6) obstruction of the descending colon by the round ligament, 7) intestinal malrotation and massive colonic dilation. The patient was treated by de-torsion of the liver, hepatopexy (by suturing the round ligament to the right abdominal wall), and colon resection. The pathophysiology of this unique condition is discussed.