Torsion of fatty tag in falciform ligament simulating perforated peptic ulcer

Abstract

WHILE the .presence of quantities of fat in the substance of the falciform ligament is a common finding, this fat is usually incorporated evenly so that the ligament presents a smooth surface.That such fat should project as a pedunculated mass from the surface is less common, and that such a tag should undergo torsion and thereby present as an abdominal emergency is a condition which does not appear to have been recorded in the literature.

Torsion of Fatty Appendage of Falciform Ligament: Acute Abdomen in a Child

“…According to our literature search, there have only been five reported adult cases of a torted fatty appendage of the falciform ligament identified on ultrasound and/or CT scan, with our case being the first paediatric case reported [ 1 , 2 , 7 – 9 ] (there were three earlier case reports of this pathology, but, as they were reported before 1977, there were no ultrasound or CT images) [ 10 – 12 ]. Each adult case presented with upper abdominal pain, with varying combinations of right upper quadrant, epigastric region, and left upper quadrant pain, and there were three cases with a mild increase in CRP or leucocytosis.…”

Primary torsion of the falciform ligament: Computed tomography and ultrasound findings

“…The treatment in all reported cases of this condition has been excision, presumably because of the condition being confused with another more serious, and more common, condition such as perforated duodenal ulcer or because of the unknown nature of the lesion 5 . In the case described here, the excision was carried out for symptomatic relief as well as to clarify the diagnosis.…”

“…Torsion of the falciform ligament is a very rare cause of acute abdominal pain with only four previous references appearing in the published work, all of which are case reports 1,2,4,5 . It does, however, seem to have a similar clinical presentation to omental torsion, that of localized peritonism in the absence of fever or elevated white cell count.…”

“…It does, however, seem to have a similar clinical presentation to omental torsion, that of localized peritonism in the absence of fever or elevated white cell count. Its importance lies in the differentiation from other more serious surgical causes of pain in the upper abdomen such as cholecystitis and perforated duodenal ulcer, 5 and in the possibility of non‐surgical intervention 6 …”

“…7 The treatment in all reported cases of this condition has been excision, presumably because of the condition being confused with another more serious, and more common, condition such as perforated duodenal ulcer or because of the unknown nature of the lesion. 5 In the case described here, the excision was carried out for symptomatic relief as well as to clarify the diagnosis. A series of seven patients was reported by Puylaert with the related entity of omental torsion in which all the patients were treated conservatively and in whom symptoms and US findings gradually resolved.…”