Purpose or Case Report: Wandering liver (WL) is a rare entity consisting of excessive mobility of the liver due to irregular hepatic fixation. We report a case of WL in a 3-year-old girl, who was referred to our department with acute abdominal pain and recurrent episodes of vomiting. Laboratory tests showed only leukocytosis. In order to define possible causes of acute abdomen an US scan of the abdomen was performed which revealed a left-sided liver, confirmed by abdominal X-ray that showed hyperlucent right upper quadrant by the presence of bowel air (Fig. 1); the hepatic shadow was seen in the midline left abdomen. As patient symptoms persisted, 24 hours after the admission a new abdominal X-ray and US scan were performed; return of the liver in normal right position was observed. Barium X-rays of the gastrointestinal tract excluded a congenital malrotation. A supine abdominal CT showed the liver normally occupying the right hypochondrium (Fig. 2); subsequently, left decubitus CT scan showed hepatic migration across the midline to the left (Fig. 3). The patient's symptoms resolved in the next few hours so she was conservatively managed and was discharged a few days later. The first documented case of wandering liver was presented by Heister in 1754 and few cases have been described ever since. The clinical presentation of wandering liver is variable and non specific. WL is often an asymptomatic condition diagnosed incidentally, although in more than 75% of cases colonic obstruction coexists. It has been reported that the cause of wandering liver is related to abnormalities of the suspensory apparatus of the liver. Such abnormalities permit excessive mobility of the liver in the transverse plane. Surgical treatment is usually reserved for symptomatic patients. In our case the patient was managed conservatively due to the lack of evidence of intestinal obstruction and the prompt relief of the symptoms, probably favored by the supine position for an extended period and return of the liver in the right abdomen. Detection of WL is difficult but it is essential in order to avoid misdiagnosis and unnecessary imaging procedures. In our experience any evidence of abnormal positioning of the liver should be investigated with serial imaging in the lateral decubitus position, mainly in children with unexplained causes of abdominal pain.
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