A 47-year-old woman with a history of known gallstone disease presented with worsening post-prandial right upper abdominal pain radiating to the back, abdominal bloating, and nausea. An ultrasound of the abdomen confirmed the diagnosis of cholelithiasis. During laparoscopic cholecystectomy, an accessory liver lobe attached to the anterior wall of the gallbladder was incidentally found. An accessory liver lobe is a rare anatomical variation that mostly remains clinically asymptomatic. Since hepatocellular carcinoma can rarely develop in an accessory liver lobe, intraoperative complete resection should be considered for both therapeutic and diagnostic purposes.

A 46-year-old woman with a history of hemorrhoids presented with right-sided abdominal pain and rectal bleeding. Preoperative imaging and intraoperative observations were suggestive of acute appendicitis. The surgical pathology of removed appendix was consistent with granulomatous appendicitis. The patient was evaluated again in two months due to persistent hematochezia and new onset of left lower quadrant abdominal pain. A diagnostic colonoscopy revealed mildly edematous mucosa in the descending colon, sigmoid colon, and rectum, and a rectal biopsy revealed patchy chronic proctitis. The biopsy of anal canal mucosa showed acute and chronic granulomatous inflammation. Based on her clinical presentation and pathology results, the diagnosis of chronic active proctitis secondary to Crohn’s disease (CD) was made. There is a debate on necessity of follow-up on patients with appendiceal CD after appendectomy as previously reported appendiceal CD usually follows a benign course post-appendectomy. However, our patient’s case progressed from granulomatous appendicitis to CD with severe GI bleeding and proctitis within only two months post-appendectomy. A high index of suspicion is needed in patients with a history of granulomatous appendicitis and lower GI bleeding to ensure prompt diagnosis and timely treatment.