Falciform ligament abscess: report of a case

Melo, Valdinaldo Aragão de; Melo, Gustavo Barreto; Silva, Renata Lemos; Aragão, João Fernandes Britto; Rosa, Jose Eraldo Marques

doi:10.1590/s0041-87812003000100008

Cited by 18 publications

(14 citation statements)

References 3 publications

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“…The reported causes of abscess of the ligamentum teres hepatis are acute calculous cholecystitis, cholangitis and pancreatitis in adults, and omphalitis and infected ventriculoperitoneal shunt in children. 3 – 10 Lipinski et al 11 proposed contiguous spread of infection from omphalitis via the round ligament as the cause of this abscess in infants. The paraumbilical veins connect the superficial periumbilical venous network to the left portal vein to form a portal–systemic venous anastomosis.…”

Section: Discussionmentioning

confidence: 99%

“…Antibiotic therapy and surgical excision are the mainstay of treatment; however, conservative management with endoscopic biliary drainage and antibiotics has also been successful. 3 – 5 , 9 Any predisposing condition such as acute calculous cholecystitis, cholangitis, choledocholithiasis and omphalitis will also need to be simultaneously addressed.…”

Section: Discussionmentioning

confidence: 99%

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The “sausage” abscess: abscess of the liagamentum teres hepatis

Sen¹,

Arora²,

Sohal³

et al. 2016

BJR|case reports

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An abscess of the ligamentum teres hepatis is a very rare cause of acute abdomen and can present a diagnostic dilemma. A 40-year-old diabetic male presented with obstructive jaundice and cholangitis. An ill-defined, sausage-shaped, tender parasagittal supraumbilical mass was palpable on the right side. Murphy’s sign was negative. Laboratory investigations revealed polymorphonuclear leukocytosis (total leukocyte count 19,000 mm–3), elevated alkaline phosphatase (400 IU l–1), conjugated hyperbilirubinaemia (16 mg dl–1) and elevated blood glucose (240 mg dl–1). Ultrasonography and MR cholangiopancreatography revealed cholecystolithiasis, obstructive choledocholithiasis, abscess of the ligamentum teres hepatis and left portal thrombosis. Under ultrasound guidance, pus was aspirated from the abscess and the patient was started on broad-spectrum intravenous antibiotics, insulin and low-molecular-weight heparin. He subsequently underwent endoscopic retrograde cholangiopancreatography with sphincterotomy and stone extraction. On the tenth day post admission, he underwent laparoscopic cholecystectomy and excision of the ligament. The patient made an uneventful recovery and was discharged on the seventh post-operative day. On follow-up, the patient remained asymptomatic with normal biochemical parameters. This article highlights the importance of suspecting and identifying an abscess of the ligamentum teres hepatis when a patient with acute abdomen presents with a sausage-shaped right parasagittal mass, especially in the setting of cholangitis, cholecystitis or omphalitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The “sausage” abscess: abscess of the liagamentum teres hepatis

Sen¹,

Arora²,

Sohal³

et al. 2016

BJR|case reports

View full text Add to dashboard Cite

show abstract

“…Falciform ligament abscess presents a difficult and perplexing problem when encountered clinically for the first time. It has been reported to occur in the setting of cholecystitis [2,3], cholecystolithiasis [4,5] and cholangitis [6]. The pathophysiology of this occurring secondary to cholecystitis or cholangitis is poorly understood [1].…”

Section: Discussionmentioning

confidence: 99%

Falciform ligament abscess from left sided portal pyaemia following malignant obstructive cholangitis

et al. 2012

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Abscess formation of the falciform ligament is incredibly rare and perplexing when encountered for the first time. It is reported to occur in the setting of cholecystitis and cholangitis, but the pathophysiology is poorly understood.In this case report, we present a 73-year-old man with falciform ligament abscess following cholangitis from an obstructive ampullary carcinoma. The patient was referred to the Royal Adelaide Hospital from a country hospital, with progressive jaundice, anorexia and nausea. Prior to transfer, he deteriorated with cholangitis, dehydration and renal failure. On arrival, his abdomen was exquisitely tender along the course of the falciform ligament. His blood tests revealed an elevated white cell count of 14.9 x 103/μl, bilirubin of 291μmol/l and creatinine of 347 μmol/l. His CA 19-9 was markedly elevated at 35,000 kU/l. A non-contrast computed tomography (CT) demonstrated gross biliary dilatation and a collection tracking along the path of the falciform ligament to the umbilicus.The patient was commenced on intravenous antibiotics and underwent an urgent endoscopic retrograde cholangiopancreatogram (ERCP) with sphincterotomy and biliary stent drainage. Cholangiogram revealed a grossly dilated biliary tree, with abrupt transition at the ampulla, which on biopsy confirmed an obstructing ampullary carcinoma. Following ERCP, his jaundice and abdominal tenderness resolved. He was optimized over 4 weeks for an elective pancreaticoduodenectomy.At operation, we found abscess transformation of the falciform ligament. Copious amounts of pus and necrotic material was drained. Part of the round ligament was resected along the undersurface of the liver. Histology showed that there was prominent histiocytic inflammation with granular acellular eosinophilic components. The patient recovered slowly but uneventfully.A contrast CT scan undertaken 2 weeks post-operatively (approximately 7 weeks after the initial CT) revealed left portal venous thrombosis, which was likely to be a delayed discovery and was managed conservatively.We present this patient’s operative images and radiographic findings, which may explain the pathophysiology behind this rare complication. We hypothesize that cholangitis, with secondary portal pyaemia and tracking via the paraumbilical veins, can cause infectious seeding of the falciform ligament, with consequent abscess formation.

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“…However, because of its rarity and obscure location, a definite radiological diagnosis of a falciform ligament abscess is difficult. Infections can extend from the liver, gallbladder (2, 3) and umbilicus (4). An infection of a cystic lesion of the falciform ligament has been reported as a cause of a falciform ligament abscess (5).…”

Section: Discussionmentioning

confidence: 99%

Falciform Ligament Abscess after Omphalitis: Report of a Case

et al. 2010

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A falciform ligament abscess is a rare type of intra-abdominal abscess. A 2-yr-old male, who had omphalitis two months previously, presented with a fever and right upper quadrant abdominal pain. The ultrasound and CT scan showed an abdominal wall abscess located anterior to the liver, which was refractory to conservative management with percutaneous draninage and antibiotics. On the third recurrence, surgical exploration was performed and revealed an abscess arising from the falciform ligament; the falciform ligament was excised. A follow up ultrasound confirmed complete resolution of the abscess with no further recurrence.

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Falciform ligament abscess: report of a case

Cited by 18 publications

References 3 publications

The “sausage” abscess: abscess of the liagamentum teres hepatis

The “sausage” abscess: abscess of the liagamentum teres hepatis

Falciform ligament abscess from left sided portal pyaemia following malignant obstructive cholangitis

Falciform Ligament Abscess after Omphalitis: Report of a Case

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