Chronic hepatitis in polymyalgia rheumatica.

of the hepatic anlage (Fraser, 1952) or by further branching of the foregut diverticulum (Ashby, 1969). Accessory lobes may be attached to the liver by a pedicle of the liver tissue or by a mesentery (Johnstone, 1965). For the accessory lobe to be viable it should have the hepatic artery, hepatic vein, portal vein and bile duct, which usually communicate through the liver, but occasionally may have extrahepatic connection as in the present case. All reported cases of this phenomenon, and their symptoms, are summarized in Table 1. Late presentation is due to gradual worsening of the circulation in the lobe. All the six cases reported were diagnosed at operation. Pre-operative diagnosis can be made by using one or more techniques of pneumoperitoneum, percutaneous hepatic cholangiography, splenic portography, regional arteriography, coelioscopy and scintillation scanning (Omanik and Jablonsky, 1972; Llorente and Dardik, 1971). References ASHBY, E.C. (1969) Accessory liver lobe attached to the gall bladder. British Journal of Surgery, 56, 311. FISHER, W., cited by CULLEN, T.S. (1925) Accessory lobes of the liver, an accessory hepatic lobe springing from the surface of the gall bladder. Archives of Surgery, 11, 718. FRASER, C.G. (1952) Accessory lobes of the liver. Annals of Surgery, 135, 127. JOHNSTONE, G. (1965) Accessory lobe of liver presenting through a congenital deficiency of anterior abdominal wall. Archives of Disease in Childhood, 40, 541. LEVI, M.N., CREQUE, L. & CINQUE, S. (1969) Accessory lobe of liver presenting symptoms of pelvic tumor. New York State Journal of Medicine, 69, 1334. LLORENTE, J. & DARDIK, H. (1971) Symptomatic accessory lobe of liver associated with absence of the left lobe. Archives of Surgery, 102, 221. LOTTEE, J. & MADIER, G. (1960) Infarction caused by torsion of accessory lobe of liver. Surgery cure. Presse Medicale, 68, 838. McGREGOR, A.L. (1950) Synopsis of Surgical Anatomy, 8th ed., p. 418. John Wright: Bristol. OMANIK, S. & JABLONSKY, I. (1972) Pedunculated accessory hepatic lobe. Archives of Surgery, 105, 792. WATSON, J.R. & LEE, R.E. (1964) Accessory lobe of liver with infarction. Archives of Surgery, 88, 490.