GI IMAGE Abdominal Pain due to a Wandering Liver Antoine Bruneau 1 & Giovanni Battista Levi Sandri 1 & Michel Rayar 1 & Laurent Sulpice 1 & Karim Boudjema 1,2 Received: 22 August 2016 /Accepted: 13 September 2016 # 2016 The Society for Surgery of the Alimentary Tract Abstract Wandering liver syndrome is an extremely rare congenital disorder. It is mainly diagnosed within the first years of life. Herein we report the case of a 40-year-old woman with hepatoptosis due to the absence of anatomical peritoneal attachments of the liver. Surgical treatment consisted in inserting the floppy right lobe of the liver in a subphrenic retroperitoneal pouch. This original technique provided excellent postoperative result. Keywords Wandering liver . Liver surgery . Hepatoptosis A 40-year-old woman presented with a long history of abdom- inal pain for which an explanation had not been found since her childhood. Her symptoms consisted of acute episodes of abdominal pain several times a week that were relieved by analgesics and bed rest in the left lateral position. More recent- ly, she also described episodes of bowel obstruction with vomiting. Performing the abdominal examination, a mass was found able to move freely from the right to the left hypochondrium. A computed tomography and a magnetic resonance imaging in the supine position and left lateral position were performed. CT and MRI revealed hepatodiaphragmatic interposition of the colon (Fig. 1a) and movement of the liver in the left upper quadrant in left lateral decubitus (Fig. 1b) with subsequent jamming of the colon in the right sub-diaphragmatic space. The liver vessels as well as the inferior vena cava remained patent. The liver tests were not modified. Therefore, a wandering liver (WL) was diagnosed. When WL is symptomatic, the main therapeutic approach is hepatopexy. The most common technique described is stitching the liver to the diaphragm. Given the few cases re- ported in the literature, it is difficult to evaluate the efficacy of this strategy for pain relief and the prevention of recurrences. At the time of operation, the liver was found floating from right to left around the retrohepatic vena cava. There were neither coronary nor triangular ligaments (Fig. 2). The surgical treatment consisted of creating a large retroperitoneal pocket (Fig. 3a); the right lobe of the liver was scarified using a cautery and then slid into the newly created space (Fig. 3b). Given the right and transverse redundant colon without peri- toneal attachment, a right extended colectomy was performed during the same operation. A CT scan with sequences in the supine and left lateral position was performed and confirmed that the right liver was well sealed in the right upper quadrant of the abdomen without colonic interposition (Fig. 4). * Karim Boudjema karim.boudjema@chu-rennes.fr 1 Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, Rennes, France 2 Service de Chirurgie Hépatobiliaire et Digestive, Pontchaillou, Université de Rennes 1, F-35033 Rennes, France J Gastrointest Surg DOI 10.1007/s11605-016-3277-x