Hepatoptosis is the lowering of the liver below the normal anatomical border, as a consequence of acquired or congenital splanchnoptosis. Most often, hepatoptosis does not manifest itself in any way, however, with a pronounced omission of the organ, pain in the right hypochondrium, hepatic colic, dyspepsia may occur. The diagnosis is reliably confirmed by ultrasound of the abdominal organs in a vertical and horizontal position; if necessary, MRI and scintigraphy are additionally prescribed. For the correction of moderate hepatoptosis, general restorative measures are usually sufficient, with pronounced liver prolapse, surgical treatment (hepatopexy).
Meaning
Hepatoptosis is a downward displacement of the liver with the formation of its pathological mobility. Normally, the lower edge of the liver in the supine position is at the level of the costal edge, in the 10th intercostal space, and in the standing position it falls no more than 1 cm. Isolated hepatoptosis is extremely rare, usually as a variant of congenital malformation in children. At an older age, hepatoptosis is one of the components of a pathological process called splanchnoptosis, in which almost all organs of the abdominal cavity are lowered.
Women and children are most susceptible to hepatoptosis, men face this disease extremely rarely. Most often, the pathology is combined with right-sided nephroptosis (in 75% of patients) and colonoptosis (in 50% of patients). This triad occurs in 62% of all cases of splanchnoptosis. Modern techniques of surgical treatment of hepatoptosis are constantly being improved, although surgery is resorted to only as a last resort.
Causes of hepatoptosis
Almost all cases of hepatoptosis are acquired. Various reasons can lead to omission of internal organs: pregnancy, sudden and significant weight loss, excessive physical exertion, elimination of long-existing ascites or removal of large abdominal tumors, volumetric processes in the right pleural cavity. These causes of hepatoptosis prevail in adult women, occasionally in men. In children, the causes of hepatoptosis are congenital: abnormalities of the structure of the ligamentous apparatus of the liver, congenital connective tissue dysplasia.
The maintenance of the abdominal organs in a certain position is influenced by a whole complex of factors: intra-abdominal and intra-intestinal pressure, the amount of visceral fat, sufficient tone of the abdominal muscles and diaphragm. In case of violation of any of these factors, the relative location of internal organs may change, causing functional disorders.
With splanchnoptosis, the omission of organs located in the right half of the abdominal cavity is more often noted: the liver, kidneys, and the right corner of the colon. Primary in this process is hepatoptosis: the descending liver presses on the right kidney and the right corner of the colon, also shifting them down. Isolated hepatoptosis practically does not occur, it is almost always combined with right-sided nephroptosis. A combination of these two options with right-sided coloptosis is also common. Sometimes the angle of the colon is determined in the right iliac region.
Symptoms of hepatoptosis
In most cases, hepatoptosis does not manifest itself in any way and does not cause much discomfort in the patient. With a significant omission, moderate pain may appear in the right hypochondrium, radiating into the lower back, shoulder and shoulder blade on the right. A pathognomonic sign is the weakening or disappearance of pain in the supine position. The edge of the liver is defined well below the costal arch, but remains thin and smooth. Often, it may not be palpated, since the liver does not just descend, but turns around its horizontal axis. At the same time, the hepatic edge is turned downwards and posteriorly.
With hepatoptosis, the liver becomes excessively mobile, while there is an inflection of the vascular bundle and gallbladder. In this situation, the patient may be concerned about hepatic colic. When the hepatic artery is inflected, ischemia of the organ occurs, the pain may increase. If the patient occupies a horizontal position, the symptoms decrease. There may also be an inflection of the colon with signs of intestinal obstruction.
Diagnostics
Most often, patients first go to the clinic for other diseases, and only with an additional examination, liver prolapse is detected. After receiving normal results of liver tests and other analyzes, the gastroenterologist prescribes a number of necessary studies.
The gold standard in the diagnosis of hepatoptosis is ultrasound of the liver and gallbladder in two positions – horizontal and vertical. During the study, significant mobility of the liver (especially its right lobe) is recorded, a large range of displacement of internal organs in the vertical plane when changing position. For differential diagnosis, an overview radiography of the abdominal cavity organs, irrigation with oral contrast in an upright position, magnetic resonance imaging – MRI of the liver and biliary tract may be required. Also, radioisotope scintigraphy of the liver plays an important role in the diagnosis of hepatoptosis – it allows you to distinguish between hepatomegaly – a true enlargement of the liver and hepatoptosis.
Differential diagnosis of hepatoptosis should be carried out with cholelithiasis, impaired functioning of the Oddi sphincter, hepatitis, chronic cholecystitis, abdominal hernias, intestinal colic and gastroptosis.
Treatment of hepatoptosis
Moderate hepatoptosis does not require active therapeutic measures. Restorative procedures are usually enough to restore the position of the liver. It is necessary to start with the observance of a high-calorie high-protein diet, thanks to which normal body weight is restored, and a sufficient fat layer fixes the internal organs in a physiological position. Then physical therapy is connected – it helps to strengthen the muscle frame. To strengthen the muscles of the press and improve the overall condition, you should take walks in the fresh air, exercise in the morning. Swimming has a wonderful restorative effect. At the same time, it is necessary to exclude heavy physical exertion, as well as exercises that cause displacement of internal organs: jumping, running, sharp bends and bending of the trunk.
If hepatoptosis is significant, or the omission of the liver causes a violation of the functioning of other organs, reduces the patient’s standard of living, surgical treatment is indicated. When planning an operation, the consultation of an endoscopist is required. There are many methods of hepatopexy, but almost all of them are quite traumatic. For example, fixing the lower right edge of the liver to the costal surface of the diaphragm requires applying small cuts to the liver capsule, and then applying deep sutures to the liver itself. In recent years, a new technique of plastic hepatopexy has been developed – the liver is fixed to the rib diaphragm using a special mesh implant. This technique allows you to give the organ a stable position, relapses of hepatoptosis are not observed with it. With simultaneous omission of the liver, kidney and colon angle, as well as complete splanchnoptosis, surgery is usually not prescribed, a course of conservative treatment is carried out aimed at restoring the position of internal organs.
If complications of hepatoptosis occur (liver infarction, cholecystitis, intestinal obstruction), urgent surgical intervention may be required to eliminate hepatoptosis and eliminate the danger to the patient’s life.
Prognosis and prevention
The prognosis for hepatoptosis is favorable if the patient follows the doctor’s instructions aimed at restoring the physiological position of the internal organs. The lack of timely treatment can lead to severe chronic liver diseases, including cirrhosis. In addition, with long-term hepatoptosis, the development of hepatocellular carcinoma is possible.
Prevention of hepatoptosis consists in observing the principles of rational nutrition, regular moderate physical activity, and maintaining a normal weight. In preparation for pregnancy, a woman should strengthen the abdominal muscles, and wear a bandage while carrying a baby.
