Small bowel obstruction via herniation through an iatrogenic defect of the falciform ligament following laparoscopic cholecystectomy

Abstract

Internal herniation of the small bowel through a defect in the falciform ligament and subsequent small bowel obstruction is exceedingly rare with the majority of previous cases being attributed to congenital abnormalities. As laparoscopic techniques approach the forefront of modern surgery, an iatrogenic source for a falciform ligament defect has emerged over the last decade. In this case, a 50-year-old patient presented with signs of acute small bowel obstruction 10 days after a laparoscopic cholecystectomy. On diagnostic laparoscopy, part of the jejunum was found to have herniated through an opening in the falciform ligament. This was likely to have been caused by trauma during the cholecystectomy. Following relief of the obstruction, the defect was closed with polyglactin sutures.

Small bowel obstruction due to internal herniation through a defect in the falciform ligament: a rare case report and review of the literature

“…Herniation through the falciform ligament is extremely rare, accounts for 0.2% of all internal hernias, and is often reported in early childhood or late pregnancy [2,4]. Incomplete development and malformation of the falciform ligament may be the probable congenital etiology for the defects in this ligament [5].…”

“…Herniation through the falciform ligament is extremely rare and the majority of cases are related to congenital defects involving malformation, hypoplasia, or complete failure of the development of the falciform ligament [2].…”

A Case Report of a Rare Hernia: Incarcerated Falciform Ligament Hernia

“…An internal hernia is a protrusion of abdominal viscera through a peritoneal or mesenteric aperture, remaining within the boundaries of the abdominal cavity [ 1 ]. A falciform ligament hernia is one rare type of internal hernia that occurs through an abnormal opening in the falciform ligament of the liver, accounting for 0.2% of all internal hernias [ 1 , 2 ]. Presenting signs and symptoms can often be nonspecific, with most case reports describing a patient with an acute onset of abdominal pain and symptoms suggestive of obstruction [ 2 ].…”

“…A falciform ligament hernia is one rare type of internal hernia that occurs through an abnormal opening in the falciform ligament of the liver, accounting for 0.2% of all internal hernias [ 1 , 2 ]. Presenting signs and symptoms can often be nonspecific, with most case reports describing a patient with an acute onset of abdominal pain and symptoms suggestive of obstruction [ 2 ]. Nevertheless, early and accurate management is crucial in preventing morbidity and mortality in these patients.…”

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

“…4 на цв. вклейке), в частности после лапароскопических вмешательств с введением троакара в эпигастральной области [16,23]. В связи с широким внедрением лапароскопических технологий следует ожидать увеличения числа пациентов с таким осложнением.…”