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

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

Falciform ligament hernias are a rare type of internal hernia that occurs through an abnormal opening in the falciform ligament of the liver. This is the case of a 38-year-old female who presented with a symptomatic enlarging ventral bulge near her umbilicus and was treated with a robotic-assisted laparoscopic falciform hernia repair with mesh. The nonspecific clinical manifestation of a falciform ligament hernia and the low sensitivity of computerized tomography (CT) for these hernias make them hard to diagnose preoperatively. Falciform ligament hernias are mostly attributed to congenital defects, but recently an iatrogenic etiology has also been proposed, given the prior history of laparoscopic surgeries in more recent cases. In our case report, we demonstrate that a robotic-assisted laparoscopic approach is a safe and effective means of correcting this hernia, with an outline of the current literature.

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

Background

The falciform ligament hernia is a type of internal herniation, caused by a defect in the falciform ligament of the liver. The etiology for this defect may be congenital or iatrogenic, created after the laparoscopic intervention.

Case presentation

A 45-year-old male was presented to our hospital, complaining of abdominal pain for 2 days. The physical examination revealed diffuse abdominal tenderness and guarding. The abdominal X-ray was suggestive of intestinal obstruction. On abdominal CT images, dilated proximal ileal loops between the left hepatic lobe and anterior abdominal wall, forming a closed-loop with mesenteric edema and fat stranding, were observed. There were findings of ileus in the jejunal loops proximal to this segment, but the ileal loops and the colon were completely collapsed, consistent with small bowel obstruction due to internal herniation through a defect in the falciform ligament. The patient underwent surgical intervention, reduction of the herniated bowel loops, and repairing the hernia defect. He had an uneventful recovery with a favorable outcome.

Conclusion

Herniation through a defect in the falciform ligament is extremely rare but should be considered in the differential diagnosis of acute abdomen. The clinical manifestations of falciform ligament hernia are nonspecific and may underestimate the diagnosis, leading to a delayed treatment that affects the management outcome. Computed tomography plays an important role in the timely diagnosis and planning of surgical intervention, precluding intestinal strangulation.

Internal hernia through hepatic falciform ligament iatrogenic defect in a neonate: A case report and review of the literature

Internal hernia through an iatrogenic defect in the hepatic falciform ligament and acquired jejunal atresia in a 8-day-old neonate was reported. The PubMed, MEDLINE, CNKI, Wanfang and Weipu databases were searched The literature about the hepatic falciform ligament iatrogenic defect causing internal hernia was analysed. Ten other cases were collected from the world literature. Herniated intestinal necrosis was found in four cases. All cases were recovered uneventfully after operation. Internal herniation through an iatrogenic defect in the hepatic falciform ligament is extremely rare. However, the case reports are increasing, especially in the era of laparoscopic surgery. Adequate closure or open the defect is essential to prevent internal hernia occurrence.

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.

Internal herniation through the falciform ligament of the liver: a case report

Background: An internal abdominal hernia is defined as the protrusion of a viscus through a mesenteric or peritoneal aperture within the peritoneal cavity. A less common type of internal herniation is a small bowel herniation through a defect in the falciform ligament of the liver. This defect can be congenital or iatrogenic after penetration of the falciform ligament with a trocar during laparoscopic surgery. Methods: We present a case report illustrating an internal herniation through an iatrogenic defect in the falciform ligament of the liver. Results: A 78-year-old man comes to the emergency department with severe abdominal pain for several hours. Laparoscopic exploration shows a small bowel herniation through an iatrogenic defect of the falciform ligament after laparoscopic cholecystectomy. Reduction of the internal herniation is performed. Due to subsequently small bowel necrosis, a small bowel resection with primary anastomosis has to be performed too. Conclusion: Small bowel herniation through an iatrogenic defect in the falciform ligament is very rare. However, it can lead to severe complications such as small bowel necrosis. To prevent internal herniation, we strongly suggest immediate repair or division of the falciform ligament when an iatrogenic defect is created during laparoscopic procedures.

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

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.