A Rare Cause of Acute Abdomen: An Isolated Falciform Ligament Necrosis

Abstract

The falciform ligament is one of the anatomical structures which attach the liver to the diaphragm and anterior abdominal wall. Primary falciform ligament is very rare. In this article, we present a case of an isolated falciform ligament necrosis, a rare primary pathology of the falciform ligament, who was admitted with acute abdomen. Case presentation: A 64-year-old female patient was admitted with the complaints of pain. Laboratory test results showed a leukocyte count of 17,000/mm3. Imaging studies demonstrated intra-abdominal reactionary fluid along with a heterogeneous mass localized in the falciform ligament. Exploratory laparotomy revealed a necrotic mass of the falciform ligament. No other pathology responsible for falciform ligament necrosis was found. We believe that falciform ligament necrosis should be considered a preliminary diagnosis, if any ligament abnormality, tumor, intraligament air density, or the presence of reactionary fluid surrounding the ligament is detected through abdominal imaging studies.

Unusual Cause of Epigastric Pain: Intra-Abdominal Focal Fat Infarction Involving Appendage of Falciform Ligament - Case Report and Review of Literature

“…Sometimes, there may be isolated necrosis of the falciform ligament with no other findings [2] . All these pathologies present with similar clinical complaints of epigastric pain with or without constitutional symptoms, closely mimicking other common gastroduodenal and pancreatic diseases.…”

“…Another reason for laparotomy was due to the possibility of necrosis and gangrene as seen in some reports [2] . In this cases also, the surgeons proceeded with surgery despite the unequivocal CT diagnosis of IFFI, due to the increasing severity of abdominal pain in the patient.…”

“…Fatty appendages of the falciform ligament may very rarely undergo torsion, leading to fat infarction [1,2] . This type of torsion or infarction, which occurs more commonly in the epiploic appendages or greater omentum and rarely involving the perigastric ligaments (gastrohepatic, gastrosplenic, and falciform), is grouped together as intra-abdominal focal fat infarction (IFFI) [3] .…”

Diagnosis of a sonographically negative extensive defect of the lig.falciforme hepatis

“…falciforme hepatis на мембранозную и жировую части [27], возможно два варианта (группы) патологических изменений связки. Первой группой (А) будут изменения мембранозной части (ее дефекты), второй группой (В) -изменения жировой части (перекрут ее части с некрозом) [26,29,32]. Возможны сочетанные изменения (С): при травматических повреждениях передней брюшной стенки и сопутствующей травме lig.…”

“…Имеющийся перекрут/некроз жировой части lig. falciforme hepatis также характеризуется особенностями клинического течения [29]. Инструментальные методы диагностики этих состояний включают КТ [26,31], УЗИ [21,24].…”