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.
The falciform ligament, which is located on the left of the midline of the abdomen, runs through the anterior wall of the abdomen and diaphragm. It is one of the anatomical structures which attaches the liver to the remnants of the umbilical veins. The length of the falciform ligament may vary individually and it contains the ligamentum teres and obliterated umbilical vein. It also contains paraumbilical veins. The falciform ligament artery originating from the liver was reported in several cases in the literature [
A 64-year-old female patient was admitted with the complaints of pain in the right upper quadrant and the epigastric region. The patient’s history revealed an abdominal pain for 24 hours with an increasing severity, as well as nausea and vomiting. Physical examination suggested peritoneal irritation with a systolic blood pressure of 100/70 mmHg, pulse rate of 140 bpm, and body temperature of 38.5°C. Laboratory test results showed a leukocyte count of 17,000/mm3 (4000–10,000/mm3). Serum chemistry tests and electrolyte measurements did not indicate any pathology related to acute abdomen. In addition, CA19-9, CEA, CA-125, and AFP tumor biomarkers were normal. The air under diaphragm demonstrated was by posteroanterior X-ray, one of the radiographic diagnostic tools and also abdominal ultrasonography demonstrated intra-abdominal reactionary fluid along with a heterogeneous mass localized in the falciform ligament. Abdominal computed tomography showed a mass lesion originating from the gallbladder extending to the periportal region and surrounding the falciform ligament without opaque-medium enhancement (Figure
An abdominal computed tomography scan showing a mass lesion (arrow) originating from the gallbladder region extending to the periportal region and surrounding the falciform ligament with air density and reactionary fluid.
Macroscopic view of surgical specimens.
Although the anatomical structure and variations of the falciform ligament are definitely defined, associated conditions of the falciform ligament remain to be elucidated. The most common pathologies include ligament cysts, tumors, and abnormal vascularization secondary to portal hypertension [
In recent years, the number of patients faced with the intraperitoneal fat tissue necrosis including the falciform ligament has been increasing parallel to the development in the field of radiology. The abdominal ultrasonography and computed tomography could provide important clues in the diagnosis of these patients. Coulier reported that the contrast-enhanced abdominal computed tomography is the gold standard for diagnosis of intraperitoneal fat necrosis as well as the follow-up of the disease [
The primary falciform ligament necrosis is often diagnosed during surgery. Coulier proposed that patients diagnosed with falciform ligament necrosis could be treated medically after excluding other disorders with a detailed history [
In conclusion, falciform ligament necrosis is an extremely rare cause of acute abdomen. Surgeons should consider falciform ligament necrosis as a preliminary diagnosis if any ligament abnormality, tumor, intraligament air density, or the presence of reactionary fluid surrounding the ligament was detected through abdominal imaging studies. Surgery is the only treatment of choice. Laparoscopy or laparotomy can be performed according to the preference and experience of the surgeon as well as the overall condition of the patient.
The authors declare that there is no conflict of interests regarding the publication of this paper.