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Adhikari R, Silwal P, Khadka A, Paudel M, Jha RM, Koirala S. Spontaneous falciform ligament necrosis: A rare case report. Radiol Case Rep 2024; 19:4385-4391. [PMID: 39165312 PMCID: PMC11334558 DOI: 10.1016/j.radcr.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 07/03/2024] [Indexed: 08/22/2024] Open
Abstract
Spontaneous and isolated necrosis of the falciform ligament is a rare condition. A 55-year-old lady presented with sudden onset of epigastric pain, fever and vomiting. Laboratory studies revealed less than three-fold increase in serum amylase and lipase levels. Ultrasound examination and contrast enhanced computed tomography (CECT) revealed features suggestive of inflammation and necrosis of the falciform ligament involving ligamentum teres hepatis and extending to the lesser omentum with an adjacent minimal ill-defined collection. Then, conservative management was started. However, the symptoms did not resolve completely. Therefore, CECT scan was repeated 12 days later which showed findings similar to previous scan with expansion and organization of the collection anterior to lesser omentum with peripheral enhancement, suggestive of an abscess. A minimally invasive approach to treatment was adopted. Aspiration of the collection was performed under ultrasound guidance. This was followed by continuation of supportive management. The patient improved clinically and was discharged. This case study highlights the importance of imaging in the diagnosis of falciform ligament necrosis. An innovative minimally invasive approach to treatment in the form of ultrasound guided aspiration may be considered when a collection is present adjacent to the necrosed falciform ligament.
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Affiliation(s)
- Roshna Adhikari
- National academy of medical sciences, Bir hospital, Kathmandu, Nepal
| | - Prabhat Silwal
- National academy of medical sciences, Bir hospital, Kathmandu, Nepal
| | - Ashish Khadka
- National academy of medical sciences, Bir hospital, Kathmandu, Nepal
| | - Mukesh Paudel
- National academy of medical sciences, Bir hospital, Kathmandu, Nepal
| | | | - Sugam Koirala
- Institute of Medicine, Maharajgung Nursing Campus, Nepal
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Singh H, Singh R, Singh RK, Sehgal G, Dewan RK. An Analysis of the Anomalous Fissure of the Ligamentum Teres Hepatis: A Morphological Perspective in the North Indian Population. Cureus 2024; 16:e58984. [PMID: 38800262 PMCID: PMC11127612 DOI: 10.7759/cureus.58984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Background The liver, being the largest internal organ of the body shows a variety of gross morphological variations about lobes, fissures and processes which may be clinically significant. Among various anatomical variations, the most found is the variant fissure for ligamentum teres hepatis. The present study was done to classify, review, compare and discuss the literature for anomalies in fissures for ligamentum teres hepatis. Methods A total of 100 formalin-preserved human livers were obtained from the Department of Anatomy of King George's Medical University, Lucknow, and studied for one year. Result In our study, 15% of the liver showed morphological variations in fissures for ligamentum teres hepatis. These were classified into four types. In type I (2%), the fissure was converted into a tunnel by pons hepatis. In type II (3%), there was an incomplete fissure for ligamentum teres hepatis extending into the diaphragmatic surface. In type III (4%), there was an incomplete fissure for ligamentum teres hepatis present only on the visceral surface. In type IV (6%), the fissure was covered by a thin membrane. Conclusion In this study of the North Indian population, 15% of liver have gross morphological variations. So thorough anatomical knowledge of the existence of variant or abnormal surface features on the liver is imperative to understanding the underlying pathology for radiologists and surgeons so that a favorable outcome can be achieved.
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Affiliation(s)
- Heena Singh
- Anatomy, King George's Medical University, Lucknow, IND
| | - Raghvendra Singh
- Forensic Medicine & Toxicology, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Rohit K Singh
- Medicine, King George's Medical University, Lucknow, IND
| | - Garima Sehgal
- Anatomy, King George's Medical University, Lucknow, IND
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Nomura Y, Sakai H, Akiba J, Hisaka T, Sato T, Goto Y, Akashi M, Fukutomi S, Muroya D, Kanno H, Okamura S, Yano Y, Yano H, Akagi Y, Okuda K. Laparoscopic left hepatectomy for a patient with intrahepatic cholangiocarcinoma metastasis in the falciform ligament: a case report. BMC Surg 2021; 21:122. [PMID: 33685435 PMCID: PMC7941886 DOI: 10.1186/s12893-021-01115-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intrahepatic cholangiocarcinoma (ICC) is primary cancer of the liver with poor prognosis because of its high potential for recurrence and metastasis. We experienced a rare case of ICC with hematogenous metastasis to the falciform ligament. We aimed to clarify the route of metastasis to the mesentery by increasing the accuracy of preoperative imaging and establish a hepatectomy to control cancer. Case presentation
An 85-year-old woman was referred to our hospital for a detailed study of progressively increasing liver tumors. She had no subjective symptoms. Her medical history showed hypertension, aneurysm clipping for cerebral hemorrhage, and gallstones. A detailed physical examination and laboratory data evaluation included tumor markers but did not demonstrate any abnormalities. On computed tomography scan, contrast-enhanced ultrasound, and magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid, the tumor appeared to be located in liver segment IV, protruding outside the liver. It appeared to contain two distinct components; we suspected ICC in the intrahepatic tumor component. Laparoscopic observation revealed that the extrahepatic lesion was an intra-falciform ligament mass; laparoscopic left hepatectomy was performed. Microscopically, the main tumor in segment IV was 15 mm in diameter and was diagnosed as moderately and poorly differentiated ICC. The tumor of the intra-falciform ligament was not continuous with the main intrahepatic nodule and was also diagnosed as ICC with extensive necrosis. There were no infiltrates in the round ligament of the liver, and several tumor thrombi were found in the small veins of the falciform ligament. Conclusions To date, there have been a few reports of metastases of primary liver cancer to the falciform ligament. At the time of preoperative imaging and pathological diagnosis, this case was suggestive of considering that the malignant liver tumor might be suspected of metastasizing to the falciform ligament. Our case improves awareness of this pathology, which can be useful in the future when encountered by hepatic specialists and surgeons.
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Affiliation(s)
- Yoriko Nomura
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Hisamune Sakai
- Department of Surgery, Kurume University Hospital, Kurume, Japan.
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Toru Hisaka
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Toshihiro Sato
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Yuichi Goto
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Masanori Akashi
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Shogo Fukutomi
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Daisuke Muroya
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Hiroki Kanno
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Shusuke Okamura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yuta Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Koji Okuda
- Department of Surgery, Kurume University Hospital, Kurume, Japan
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Bangeas P, Bitzika S, Loufopoulos P, Drevelegkas K, Papadopoulos VN. Infarcted ligamentum teres hepatis lipoma mimicking acute abdomen in a female patient: a case report and mini-review of the literature. J Surg Case Rep 2020; 2020:rjaa391. [PMID: 33173575 PMCID: PMC7602364 DOI: 10.1093/jscr/rjaa391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 11/20/2022] Open
Abstract
Lipomas of the ligamentum teres hepatis are extremely uncommon. There have been only a few cases reported in the literature, including lipomas of the falciform ligament of the liver. Here we report a case of torsion and infarction of a lipoma of the ligamentum teres hepatis in a 43-year-old female patient, who presented with acute epigastric pain, nausea and vomiting. Diagnosis was based on computed tomography and magnetic resonance imaging. Patient underwent exploratory laparoscopy followed by laparoscopic excision of the infracted lipoma. Finally, we also provide a mini-review of the literature in order to highlight that although rare, this pathology should be included in the differential diagnosis of acute abdomen.
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Affiliation(s)
- P Bangeas
- 1st University Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece
| | - S Bitzika
- 1st University Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece
| | - P Loufopoulos
- 1st University Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece
| | - K Drevelegkas
- Radiology Department, General Clinic of Thessaloniki PC 54622, Thessaloniki 546 45, Greece
| | - V N Papadopoulos
- 1st University Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece
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Vozlyublenniy DE, Vozlyublenniy EI. [Diagnosis of a sonographically negative extensive defect of the lig.falciforme hepatis]. Khirurgiia (Mosk) 2018:78-80. [PMID: 30113599 DOI: 10.17116/hirurgia2018878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study assess the US diagnose of very rate extensive trapezoidal defect lig.falciforme hepatis. 2 patients with this condition were examined. Transabdominal ultrasound of this condition was unsuccessful, specific sonographic features of the defect is not revealed.
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Affiliation(s)
- D E Vozlyublenniy
- Department of Adult Surgery of City Hospital No. 20 in Rostov-on-Don; Department of Surgical Diseases #2 of Rostov State Medical University of Healthcare Ministry of the Russian Federation, Rostov-on-Don, Russia
| | - E I Vozlyublenniy
- Department of Adult Surgery of City Hospital No. 20 in Rostov-on-Don
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A Rare Finding of Falciform Ligament Thrombosis as a Sequel of Acute Pancreatitis. Case Rep Radiol 2017; 2017:2879568. [PMID: 29403671 PMCID: PMC5748311 DOI: 10.1155/2017/2879568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/23/2017] [Indexed: 01/16/2023] Open
Abstract
Falciform ligament (remnant of umbilical vein) is an anatomical structure that connects the liver to the anterior abdominal wall. This case reports a rare clinical presentation of falciform ligament thrombosis as a consequence of acute gallstone pancreatitis, in a patient with noncirrhotic liver. A 55-year-old female with a history of cholelithiasis was admitted with abdominal pain. Biochemistry profile showed hyperamylasemia and deranged liver function tests. Computerized Tomography (CT) revealed a 3 cm attenuated structure that can be traced up to the left portal vein, which represents an acute thrombosis of the falciform ligament. The patient was treated with Tinzaparin and subsequently anticoagulated. She subsequently had a laparoscopic cholecystectomy and made an uneventful recovery. We suspect that pancreatitis caused thrombophlebitis subsequently leading to recanalization and thrombosis of the umbilical vein. Falciform ligament thrombosis is a rare and poorly described complication following pancreatitis which clinicians and radiologists should be aware of.
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Indiran V, Dixit R, Maduraimuthu P. Unusual Cause of Epigastric Pain: Intra-Abdominal Focal Fat Infarction Involving Appendage of Falciform Ligament - Case Report and Review of Literature. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2017; 25:179-183. [PMID: 29998163 DOI: 10.1159/000484528] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/18/2017] [Indexed: 11/19/2022]
Abstract
Torsion of the fatty appendage of the falciform ligament, part of the spectrum of conditions known as intra-abdominal focal fat infarction (IFFI), is very rare with less than 20 cases reported on imaging so far. Here we report a case of torsion of the lipomatous appendage of the falciform ligament in a middle-aged female, diagnosed on ultrasound and computed tomography (CT). CT showed classical "hyperattenuating rim" sign in the anterior perihepatic space adjacent to the falciform ligament. We re-emphasize the importance of "hyperattenuating rim" sign on CT in recognizing IFFI in locations other than the pericolic region.
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Affiliation(s)
| | - Rishi Dixit
- Sree Balaji Medical College and Hospital, Chennai, India
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Maccallum C, Eaton S, Chubb D, Franzi S. Torsion of Fatty Appendage of Falciform Ligament: Acute Abdomen in a Child. Case Rep Radiol 2015; 2015:293491. [PMID: 26664796 PMCID: PMC4667055 DOI: 10.1155/2015/293491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 11/22/2022] Open
Abstract
Torsion of the fatty appendage of the falciform ligament is an extremely rare condition that leads to severe abdominal pain and raised inflammatory markers. It can be recognised on ultrasound or CT scan. The pathophysiology is the same as that involved in the more common torsion and/or infarction of the greater omentum or epiploic appendages. The condition is best managed conservatively with anti-inflammatory analgesia, and the early recognition of this type of torsion may prevent unnecessary operative intervention to look for a source of abdominal pain. There have been five reported adult cases of a torted fatty appendage of the falciform ligament identified on ultrasound and CT scan, but no paediatric cases. We report a case of torsion of the fatty appendage of the falciform ligament in a ten-year-old boy and describe its imaging characteristics on CT scan.
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Affiliation(s)
- Caroline Maccallum
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Sarah Eaton
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Daniel Chubb
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Stephen Franzi
- Department of General Surgery, Northeast Health Wangaratta, Wangaratta, VIC 3677, Australia
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