[Internal hernia through the falciform ligament: a rare cause of intestinal obstruction]

Absence of Falciform Ligament Found During Laparoscopic Surgery: A Case Report

Anatomic variants of hepatic ligaments are rare, and complications attributable to these variants may be difficult to diagnose. Our aim is to contribute to the literature surrounding the incidental finding of a congenital absence of the falciform ligament. We report the case of a 37-year-old man who underwent a laparoscopic cholecystectomy for acute cholecystitis. During the operation, the patient was noted to have an apparent absence of the falciform ligament attachment to the liver. The round ligament was attached from the liver to the anterior abdominal wall at the level of the umbilicus. The round ligament is inserted into the inferior surface of the liver as a thick, cordlike structure encased in fat. In rare cases, the small intestine can pass through a falciform ligament defect and become trapped while remaining within the peritoneal cavity, leading to difficult-to-diagnose internal hernias. This condition can lead to intestinal obstruction, incarceration, and strangulation. This directed our decision to divide the remaining round ligament at the liver and close to the abdominal wall. When defects of hepatic ligaments are found incidentally during laparoscopic surgery, these investigators recommend that the operating surgeon consider dividing the remaining ligament as a protective procedure to prevent complications such as internal hernias, intestinal obstruction, incarceration, and strangulation.

Falciform ligament hernia with specific abdominal symptom

Falciform ligament hernia is a very rare internal hernia and is difficult to diagnose before surgery. We report a case of falciform ligament hernia with a specific symptom and image findings, which led to an accurate diagnosis and subsequent laparoscopic surgery. A 15-year-old adolescent boy with no previous medical history showed epigastric pain and was referred to our hospital. The abdominal pain was strong in the supine position and was alleviated in the knee-chest position. Contrast-enhanced computed tomography showed that the round ligament was recognized as a cord-like structure, and the mesentery of the small intestine was located at the cranioventral side of the ligament. He was diagnosed as having falciform ligament hernia, and emergency laparoscopic surgery was performed. The small intestine passed through the falciform ligament; however, it showed no sign of ischemia, and bowel resection was not required. The malposed intestine was repositioned, and the falciform ligament was cut to prevent hernia recurrence. The specific abdominal symptom and computed tomography image finding were useful to make the correct diagnosis in this case.