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Sharma G, Tarafdar S, Yadav AK, Sah P. Isolated Inflammatory Necrosis of the Falciform Ligament: A Case Report with Review of Literature. J Med Ultrasound 2024; 32:83-85. [PMID: 38665335 PMCID: PMC11040490 DOI: 10.4103/jmu.jmu_83_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 04/28/2024] Open
Abstract
Inflammatory necrosis of the falciform ligament is an extremely rare cause of acute right upper quadrant pain. Due to overlapping symptoms with pathologies affecting the gall bladder and liver, this poses a diagnostic challenge with limited existing literature. Here, we report a case of a 62-year-old female patient presenting in the accident and emergency department with right upper quadrant pain. The patient underwent ultrasonography and revealed thickened and echogenic falciform ligament. Further, a computed tomography revealed swollen falciform ligament with associated fat stranding. The patient was kept under conservative management and improved over 2 weeks.
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Affiliation(s)
- Garima Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Swarnava Tarafdar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Abhishek Kumar Yadav
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pankaj Sah
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Ahn K, Kim WB, Kim YS, Joo SP, Kim TS. Microsurgical strategies for small unruptured dorsal internal carotid artery aneurysms. J Cerebrovasc Endovasc Neurosurg 2023; 25:475-484. [PMID: 37828745 PMCID: PMC10810722 DOI: 10.7461/jcen.2023.e2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE This study aimed to develop microsurgical strategies based on the anatomical relationship between dorsal internal carotid artery (ICA) aneurysms, the falciform ligament (FL), and the anterior clinoid process (ACP). METHODS Between 2017 and 2022, 25 patients with unruptured dorsal ICA aneurysms (less than 4 mm in diameter) underwent microsurgical direct clipping. These cases involved the left ICA (n=17) and the right ICA (n=8), with a mean aneurysm size of 3.3 mm (range, 2.5 to 4 mm). We used computed tomography angiography (CTA) and digital subtraction angiography to elucidate the anatomical relationship between dorsal ICA aneurysms and other structures. All procedures involved an ipsilateral pterional approach with securement of the ipsilateral cervical ICA for proximal control. RESULTS Among the 25 dorsal ICA aneurysms, 8 (32%) were clipped without the FL being incised. Another 5 (20%) were clipped solely after the FL was cut. For the remaining 12 cases, the aneurysms were successfully clipped following FL incision and partial ACP removal. Patients exhibited favorable postoperative recoveries with good outcomes, and postoperative CTA revealed complete aneurysm clipping without any residual remnants. Conclusions: We were able to perform clipping without removing the ACP in 13 patients (52%), and in 8 of these (32%), the clipping was carried out directly without cutting the FL. Microsurgery, coupled with proximal control of the cervical ICA, can serve as a viable alternative for patients with small dorsal ICA aneurysms, especially when endovascular treatment options are limited, and 3D CTA confirms a clear anatomical relationship with the ACP.
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Affiliation(s)
- Kanghee Ahn
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Woong-beom Kim
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - You-Sub Kim
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Tae-Sun Kim
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Diallo M, Haberlay M, Bujor PC. A rare localisation of intra-abdominal focal fat infarction: The falciform ligament. Contribution of imagery. Morphologie 2022; 106:115-117. [PMID: 33642179 DOI: 10.1016/j.morpho.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
Pathological conditions of the falciform ligament are rare, one of which is the twisting of a fatty fringe that can lead to fatty infarction of the peritoneal fat. To our knowledge, only 21 cases with radiological documentation have been published in the literature. Ultrasound and computed tomography facilitated prompt diagnosis of this rare finding. The condition is best managed conservatively, but sometimes, a surgical intervention is necessary. We report herein a case of torsion of fatty falciform ligament appendage in a 73-year old female.
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Affiliation(s)
- M Diallo
- Service de radiologie et d'imagerie médicale, hôpital principal de Dakar, 1, avenue Nelson Mandela, BP 3006, 12500 Dakar, Senegal.
| | - M Haberlay
- Service d'imagerie digestive et oncologique, centre hospitalier de Valenciennes, avenue Désandrouin, B.P 479, 59322 Valenciennes cedex, France
| | - P C Bujor
- Service de chirurgie vasculaire, centre hospitalier de Valenciennes, avenue Désandrouin, B.P 479, 59322 Valenciennes cedex, France
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Son TQ, Hoc TH, Huong TT, Long VD, Tung TT, Quyet NC, Panha L, Van Chi N. Outcomes of surgical management of peptic ulcer perforation using the falciform ligament: A cross-sectional study at a single centre in Vietnam. Ann Med Surg (Lond) 2021; 67:102477. [PMID: 34188907 DOI: 10.1016/j.amsu.2021.102477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Peptic ulcer perforation (PUP) is one of the most common critical surgical emergencies. The omentum flap is commonly used to cover a PUP. However, the omentum cannot be used in cases of severe peritonitis or previous surgical removal. This is the first study conducted in Vietnam that was designed to analyse the outcomes of patients with PUPs who were treated using the falciform ligament. Method In this study, we retrospectively identified 40 consecutive patients who were treated for PUP at a single high-volume centre in Vietnam from February 2018 to February 2021. Peptic ulcer perforation was measured during diagnostic evaluation based on preoperative imaging, such as X-ray, and CT scan. Patients who had malignancy, laparoscopic surgery, omentopexy and nonoperative treatment were excluded from this research. Results Forty patients were included; the mean age of the patients was 66.3 years (range 33–99 years), and some patients had comorbid disease (57.5%), hypertension (30%), diabetes (10%), cirrhosis (7.5%), and chronic renal failure (7.5%). The PUPs were located in the duodenum (80%), or the pyloric (15%) and prepyloric (5%) regions. The procedures used to treat the patients included duodenostomy (32.5%), gastrojejunostomy (37.5%), and antrum resection (2.5%). The average operative time was 88.6 min (45–180 min), hospital stay was 9.6 days (2–35 days), and oral intake was started at 4.1 days (3–8 days); additionally, the 30-day mortality (17.5%) and incidences of pneumonia (25%), multiorgan failure (15%), acute liver failure (5%), wound infection (7.5%), and ulcer peptic fistula (0%) were assessed. Univariate tests showed that an ASA ≥ III and comorbidities, such as pulmonary complications, liver failure and multiorgan failure, were associated with mortality. The multivariate test showed that multiorgan failure was the only factor related to mortality. Conclusion The falciform ligament can be efficiently used for the closure of a PUP. Although there were no instances of complication with a reperforated peptic ulcer, the mortality rate was slightly highly related to severe comorbidities and postoperative multiorgan failure. Peptic ulcer perforation is one of the most common surgical emergencies with an overall mortality rate is between 1.3% and 20%. Comorbidities, over 70 years old, having surgical therapy after 36 hours, and postoperative complications are associated with mortality. Using falciform ligament to replace the traditional omental patch is interesting, easy applying and efficiently in the closure of PUP. The mortality and complications were still high related to severe comorbidity and multiorgan failure after surgery.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Baskaran V, Banerjee JK, Ghosh SR, Kumar SS, Anand S, Menon G, Mishra DS, Saranga Bharathi R. Applications of hepatic round ligament/ falciform ligament flap and graft in abdominal surgery-a review of their utility and efficacy. Langenbecks Arch Surg 2021; 406:1249-1281. [PMID: 33411036 DOI: 10.1007/s00423-020-02031-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Despite their ubiquitous presence, easy availability and diverse possibilities, falciform ligament and hepatic round ligament have been used less frequently than their potential dictates. This article aims to comprehensively review the applications of hepatic round ligament/falciform ligament flap and graft in abdominal surgery and assess their utility and efficacy. METHODS Medical literature/indexing databases were searched, using internet search engines, for pertinent articles and analysed. RESULTS The studied flap and graft have found utility predominantly in the management of diaphragmatic hernias, gastro-oesophageal reflux disease, peptic perforations, biliary reconstruction, venous reconstruction, post-operative pancreatic fistula, post-pancreatectomy haemorrhage, hepatic cyst cavity obliteration, liver bleed, sternal dehiscence, splenectomy, reinforcement of aortic stump, feeding access, diagnostic/therapeutic access into portal system, composite tissue allo-transplant and ventriculo-peritoneal shunting where they have exhibited the desired efficacy. CONCLUSIONS Hepatic round ligament/falciform ligament flap and graft are versatile and have multifarious applications in abdominal surgery with some novel and unique uses in hepatopancreaticobiliary surgery including liver transplantation. Their evident efficacy needs wider adoption to realise their true potential.
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Affiliation(s)
| | - Jayant Kumar Banerjee
- Department of Gastro-intestinal Surgery, Bharati Vidyapeeth Medical College, Pune, India
| | - Sita Ram Ghosh
- Department of Gastro-intestinal Surgery, Command Hospital (Eastern Command), Kolkata, India
| | - Sukumar Santosh Kumar
- Department of Gastro-intestinal Surgery, Command Hospital (Central Command), Lucknow, Uttar Pradesh, 226002, India
| | | | - Govind Menon
- Department of Plastic & Reconstructive Surgery, Command Hospital (Central Command), Lucknow, India
| | | | - Ramanathan Saranga Bharathi
- Department of Gastro-intestinal Surgery, Command Hospital (Central Command), Lucknow, Uttar Pradesh, 226002, India.
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Shao Y, Feng J, Jiang Y, Hu Z, Wu J, Zhang M, Shen Y, Zheng S. Feasibility of mesentericoportal vein reconstruction by autologous falciform ligament during pancreaticoduodenectomy-cohort study. BMC Surg 2021; 21:4. [PMID: 33397346 PMCID: PMC7783990 DOI: 10.1186/s12893-020-01019-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mesentericoportal vein (MPV) resection in pancreatic ductal adenocarcinoma (PDAC) surgery has become a common procedure. A few studies had described the use of falciform ligament (FL) for MPV reconstruction and received encouraging preliminary effects. AIMS This study was designed to explore the feasibility and efficacy of this technique compared with others. METHODS Patients who underwent pancreaticoduodenectomy (PD) with MPV resection for PDAC from 2009 to 2018 were enrolled. Medical records were retrospectively reviewed, MPV reconstructions using FL were distinguished and compared with other techniques. RESULTS 146 patients underwent MPV reconstruction, and 13 received FL venoplasty. Other reconstruction techniques included primary end-to-end anastomosis (primary, n = 30), lateral venorrhaphy (LV, n = 19), polytetrafluoroethylene conduit interposition (PTFE, n = 24), iliac artery (IA) allografts interposition (n = 47), and portal vein (PV) allografts interposition (n = 13). FL group holds the advantages of shortest operation time (p = 0.023), lowest blood loss (p = 0.109), and shortest postoperative hospital stay (p = 0.125). The grouped patency rates of FL, primary, LV, PTFE, IA, and PV were 100%, 90%, 68%, 54%, 68%, and 85% respectively. Comparison displayed that FL had the highest patency rate (p = 0.008) and lowest antiplatelet/anticoagulation proportion (p = 0.000). Complications and long-term survival were similar among different techniques. The median survival time of patent group (24.0 months, 95% CI: 22.0-26.0) was much longer than that of the thrombosed (17.0 months, 95% CI: 13.7-20.3), though without significant difference (P = 0.148). CONCLUSIONS PD with MPV resection and reconstruction by FL is safe, feasible, and efficacious, it might provide a potential benefit for patients.
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Affiliation(s)
- Yi Shao
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jiaojiao Feng
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Yuancong Jiang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Zhenhua Hu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jian Wu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Min Zhang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Yan Shen
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Shusen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China. .,Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, No. 79 QingChun Road, Hangzhou, 310003, Zhejiang, People's Republic of China.
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Maehira H, Iida H, Mori H, Yasukawa D, Maekawa T, Muramoto K, Takebayashi K, Kaida S, Miyake T, Tani M. Superior perianastomotic fluid collection in the early postoperative period affects pseudoaneurysm occurrence after pancreaticoduodenectomy. Langenbecks Arch Surg 2021; 406:1461-1468. [PMID: 33389107 DOI: 10.1007/s00423-020-02072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Pseudoaneurysm (PA) after pancreaticoduodenectomy (PD) is a harmful complication due to postoperative pancreatic fistula. However, the preventive method for PA is unclear. This study aimed to assess the risk factors for PA after PD and to evaluate the clinical features of patients with PA. METHODS Medical records of 54 patients who underwent PD and developed clinically relevant postoperative pancreatic fistula (POPF) were retrospectively reviewed. We evaluated postoperative computed tomography (CT) findings, including the perianastomotic fluid collection (PFC) location on postoperative day 4. Perioperative findings and postoperative CT findings were compared between patients with and without PA after PD. RESULTS The PA group included nine patients (17%). The median postoperative day of diagnosis of PA was 17 (range, 7-33). The PA locations were the gastroduodenal artery stump (n = 3), dorsal pancreatic artery (DPA) stump from the common hepatic artery (n = 4), DPA stump from the replaced right hepatic artery (n = 1), and inferior pancreaticoduodenal artery stump (n = 1). The prevalence of falciform ligament wrap to the hepatic artery was lower (33% vs. 78%, p = 0.014) and superior PFC prevalence was higher (100% vs. 58%, p = 0.019) in the PA group than in the non-PA group. Superior PFC reached the dorsal part of the caudate lobe of the liver in all patients with PA. Furthermore, all PAs occurred at the arteries that could not be wrapped by the falciform ligament. CONCLUSION Prevention of superior PFC and falciform ligament wrapping may reduce PA occurrence after PD with clinically relevant POPF.
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Affiliation(s)
- Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Takeru Maekawa
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Keiji Muramoto
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Katsushi Takebayashi
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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Altafulla JJ, Iwanaga J, Kikuta S, Prickett J, Ishak B, Uz A, Dumont AS, Tubbs RS. The falciform ligament: Anatomical study with microsurgical implications. Clin Neurol Neurosurg 2020; 195:106049. [PMID: 32652394 DOI: 10.1016/j.clineuro.2020.106049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The current study aims to increase awareness of the falciform ligament and its anatomical and surgical relationships, for the benefit of the neurosurgeon. PATINENTS AND METHODS Twenty-four sides from twelve Caucasian cadaveric heads (all fresh-frozen) were used in this study. The length and thickness of the falciform ligament were recorded. The relationship of the falciform ligament to the optic nerve was also observed and documented. Finally, the force needed to avulse the falciform ligament was recorded. RESULTS In all specimens, the ligament was identified as a continuation of the outer dural layer, forming a roof at the entrance of the optic canal. The mean medial-to-lateral length, anteroposterior length, and thickness of the falciform ligament were 7.97 mm, 2.12 mm, and 0.26 mm, respectively. The mean distance from the medial attachment of the ligament to the midline was 5.54 mm. For the undersurface of the falciform ligament, the optic nerve occupied the middle third in 50.0 %, the lateral third in 44.4 %, and the medial third in 5.6 % of sides. The mean optic nerve diameter at the entrance of the optic canal was 4.20 mm. The mean failure force was 2.47 N. CONCLUSION The anatomical measurements and relationships provided in this description of the falciform ligament serve as a tool for surgery selection and planning, as well as an aid to improving microsurgical techniques, with the final goal being better patient outcomes.
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Yhoshu E, Piplani R, Chaudhary G, Garg S. Large falciform ligament cyst in a child: A rare entity of peritoneal cysts and review of the literature. Afr J Paediatr Surg 2020; 17:111-114. [PMID: 33342846 PMCID: PMC8051620 DOI: 10.4103/ajps.ajps_21_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Peritoneal cysts are not uncommon in children - mesenteric/omental cysts being the commoner entity. Peritoneal cysts in the falciform ligament are a very rare entity reported in the literature. We present a 5-year-old boy who presented with pain upper central abdomen and few episodes of non-bilious vomiting for 1 year. He was stable on examination, with abdominal examination revealing the fullness of the abdomen with palpable generalised cystic mass which was mobile transversely. Ultrasound and contrast-enhanced computed tomography of the abdomen revealed intra-peritoneal cystic lesion measuring 13 cm × 11.5 cm × 9 cm with septations seen in the abdominal cavity from the epigastric region to the infraumbilical region (D11-L5 level). Laparoscopy showed a large cyst of the abdomen arising from the anterior abdominal wall, along the falciform ligament. The dark yellow fluid was aspirated and the cyst was excised leaving a part which was adherent to the anterior wall. Histopathology revealed cuboidal epithelium lined by the fibrous wall. The patient is doing well at 6 months follow-up. Falciform ligament cysts are very rare and laparoscopy can confirm the diagnosis as well as help in excision of the cyst with good results.
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Affiliation(s)
- Enono Yhoshu
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajat Piplani
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Gyanendra Chaudhary
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sakshi Garg
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Abstract
Epigastric hernia involving the falciform ligament is exceptionally rare. Most reported cases are incisional hernia secondary to prior abdominal surgery. We report a case of primary falciform ligament herniation into the epigastric region repaired by the laparoscopic preperitoneal approach. In this case, an accompanying vessel along the herniated falciform ligament was identified. This finding provides a basis for the hypothesis of a perforating vessel piercing the linea alba and thereby creating a weak point for hernia protrusion (Moschowitz theory). The patient had an uneventful recovery and was discharged home on the postoperative day two. A laparoscopic preperitoneal approach is feasible for the repair of primary falciform ligament herniation. The magnified endoscopic view enables surgeons to achieve definite repair without missing occult defects.
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Affiliation(s)
- T J Liang
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Yang-Ming University, Taipei, Taiwan
| | - K C Wang
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - C C Tsai
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - I S Chen
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Mahmoudi A, Rami M, Khattala K, El Madi A, Bouabdallah Y. Falciform ligament abscess secondary to a ruptured liver abscess in a child: a case report. Pan Afr Med J 2020; 35:21. [PMID: 32341742 PMCID: PMC7170734 DOI: 10.11604/pamj.2020.35.21.8592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/03/2016] [Indexed: 11/11/2022] Open
Abstract
Abscess of the liver ligaments is extremely rare, and abscess of the falciform ligament has been sporadically reported. We report the case of a 3 years old male who presented with a three days history of right upper quadrant abdominal pain, fever and nausea. The ultrasound and computed tomography (CT) scan showed an abdominal wall abscess located anterior to the liver. The patient underwent surgery. Abscess of the falciform ligament secondary to a ruptured liver abscess was found. Excision of the falciform ligament including the abscess was performed. Although pathology of the falciform ligament is rare, it should be included in the differential diagnosis of acute abdomen.
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Affiliation(s)
- Abdelhalim Mahmoudi
- Department of Pediatric Surgery, CHU Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mohammed Rami
- Department of Pediatric Surgery, CHU Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Khalid Khattala
- Department of Pediatric Surgery, CHU Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Aziz El Madi
- Department of Pediatric Surgery, CHU Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Youssef Bouabdallah
- Department of Pediatric Surgery, CHU Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Bhatt A, Robinson E, Cunningham SC. Spontaneous inflammation and necrosis of the falciform and round ligaments: a case report and review of the literature. J Med Case Rep 2020; 14:17. [PMID: 31969190 PMCID: PMC6977350 DOI: 10.1186/s13256-019-2335-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 12/05/2019] [Indexed: 11/30/2022] Open
Abstract
Background Necrosis of the falciform and round ligaments is extremely rare, thus making the diagnosis challenging. It is often misdiagnosed as gallbladder pathology due to the presenting symptoms. Due to the rarity of this pathology, there is limited literature available. Case presentation A 53-year-old white man presented to our hospital with signs and symptoms of gallbladder pain but turned out to have the rare entity of necrosis of the falciform and round ligaments. An extensive review of the world literature was performed using PubMed. Manual cross-referencing of reference lists was performed to obtain all available articles. The personal operative log of the senior author was also searched to reveal one additional case. Statistical analysis was descriptive only, given the small number of reported cases. Thirty-nine articles were found, among which forty-three case were identified, and one additional case was extracted from the operative log of the senior author. Unlike previous reports, we found that isolated inflammation and necrosis of the ligaments occurs at nearly the same frequency in both men and women, not predominantly in women as previously reported in smaller series. The mean age at presentation was 59.5 years old, and cases were typically initially diagnosed as gallbladder pathology, most commonly acute cholecystitis. Computed tomography more frequently than ultrasound revealed the falciform and round-ligament pathology. Conclusions Isolated falciform and round-ligament inflammation and necrosis is a rare condition that is difficult to diagnose because it can present mimicking a wide variety of intra-abdominal pathologies, particularly gallbladder pathologies. It is often best treated by laparoscopic resection. Unlike prior reports, our review of the literature, which is the largest that we know of to date, shows that males and females are equally affected. Greater awareness of this entity will aid in future diagnosis.
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Affiliation(s)
- Astha Bhatt
- Department of Surgery, St. Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore, MD, 21229, USA
| | - Emmanuel Robinson
- Department of Surgery, St. Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore, MD, 21229, USA
| | - Steven C Cunningham
- Department of Surgery, St. Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore, MD, 21229, USA.
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14
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Vanderschueren L, Coulier B. Focal Fat Infarction of the Falciform Ligament: Typical CT Appearance of a Rare Form of Intra-peritoneal Focal Fatty Infarction. J Belg Soc Radiol 2019; 103:28. [PMID: 31119203 DOI: 10.5334/jbsr.1793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Matsumoto M, Mizutani T, Sugiyama T, Sumi K, Nakajo T, Arai S. Distance Between the Falciform Ligament and Distal Dural Ring as a Surgical Landmark for the Treatment of Paraclinoid Aneurysms. World Neurosurg 2019:S1878-8750(18)32943-7. [PMID: 30615993 DOI: 10.1016/j.wneu.2018.12.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE It is difficult to completely comprehend the anatomy of the structures surrounding the paraclinoid region before aneurysm and tumor treatment therein. When treating paraclinoid aneurysms, it is important to determine the location of the aneurysm as intradural or extradural. Thus, accurate prediction of the position of the distal dural ring (DDR) is necessary. To this end, we focused on the falciform ligament (FL), which is easily visualized on images based on its anatomic features. We measured the distance between the FL and the DDR in patients undergoing paraclinoid aneurysm operations. METHODS Between January 2017 and July 2018, 15 patients who underwent clipping for paraclinoid aneurysm treatment were retrospectively identified. The distance between the FL and the DDR was measured using a microscale at the time of the operation. RESULTS The patients comprised 14 women and 1 man. The mean aneurysm diameter was 7.29 ± 2.21 mm and the median size was 6.5 mm. Eleven of the aneurysms were on the left and 4 were on the right side. The mean distance between the FL and the DDR was 3.50 ± 0.17 mm and the median distance was 3.50 mm. The distance between the FL and the DDR was almost the same across cases (3.5 mm). CONCLUSIONS The position of the FL can be easily predicted using preoperative three-dimensional computed tomography angiography based on its anatomic features. In this study, the DDR was located 3.5 mm proximal to the FL along the internal carotid artery. This information is useful for predicting the position of the DDR.
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16
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Abstract
Systematic radial EUS imaging can provide a detailed evaluation of most of the liver segments, liver hilum, and hilar and intra-hepatic vascular and ductal anatomy. Innumerable scan planes are possible, and the endosonographers must reference the intra-hepatic vascular structures and ligaments, surface landmarks such as the gallbladder, and adjacent organs such as cardiac chambers and kidneys to define the liver segments. There is no strict demarcation between the adjacent segments, and all estimates are rough approximations. Radial EUS cannot sample detected lesions but can comprehensively evaluate the liver for any pathology. In particular, the superior part of the right anterior sector (S8), S4, and S6 are better seen with the radial than linear EUS probe. Unlike common belief, the liver hilum can also be well evaluated with the radial EUS probe from the mid and upper gastric body, similar to linear probe EUS imaging. Radial EUS imaging of the liver is carried out from three stations: gastroesophageal junction, upper-mid gastric body, and antrum-duodenal bulb. We describe a step-by-step approach to radial EUS description of liver anatomy in this pictorial review.
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Affiliation(s)
- Vikram Bhatia
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vinay Dhir
- Department of Gastroenterology and Endoscopy, S L Raheja Hospital, Mumbai, Maharashtra, India
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Sharma M, Somani P, Rameshbabu CS, Sunkara T, Rai P. Stepwise evaluation of liver sectors and liver segments by endoscopic ultrasound. World J Gastrointest Endosc 2018; 10:326-339. [PMID: 30487943 PMCID: PMC6247100 DOI: 10.4253/wjge.v10.i11.326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/16/2018] [Accepted: 10/17/2018] [Indexed: 02/06/2023] Open
Abstract
The liver has eight segments, which are referred to by numbers or by names. The numbering of the segments is done in a counterclockwise manner with the liver being viewed from the inferior surface, starting from Segment I (the caudate lobe). Standard anatomical description of the liver segments is available by computed tomographic scan and ultrasonography. Endoscopic ultrasound (EUS) has been used for a detailed imaging of many intra-abdominal organs and for the assessment of intra-abdominal vasculature. A stepwise evaluation of the liver segments by EUS has not been described. In this article, we have described a stepwise evaluation of the liver segments by EUS. This information can be useful for planning successful radical surgeries, preparing for biopsy, portal vein embolization, transjugular intrahepatic portosystemic shunt, tumour resection or partial hepatectomy, and for planning EUS guided diagnostic and therapeutic procedures.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut 25001, Uttar Pradesh, India
| | - Piyush Somani
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut 25001, Uttar Pradesh, India
- Department of Gastroenterology, Thumbay Hospital, Dubai 415555, United Arab Emirates
| | | | - Tagore Sunkara
- Department of Gastroenterology and Hepatology, the Brooklyn Hospital Center, Clinical Affliate of The Mount Sinai Hospital, Brooklyn, NY 11201, United States
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute, Lucknow 226014, Uttar Pradesh, India
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18
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Sharma M, Somani P, Rameshbabu CS. Linear endoscopic ultrasound evaluation of hepatic veins. World J Gastrointest Endosc 2018; 10:283-293. [PMID: 30364872 PMCID: PMC6198311 DOI: 10.4253/wjge.v10.i10.283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/03/2018] [Accepted: 08/13/2018] [Indexed: 02/06/2023] Open
Abstract
Liver resection surgery can be associated with significant perioperative mortality and morbidity. Extensive knowledge of the vascular anatomy is essential for successful, uncomplicated liver surgeries. Various imaging techniques like multidetector computed tomographic and magnetic resonance angiography are used to provide information about hepatic vasculature. Linear endoscopic ultrasound (EUS) can offer a detailed evaluation of hepatic veins, help in assessment of liver segments and can offer a possible route for EUS guided vascular endotherapy involving hepatic veins. A standard technique for visualization of hepatic veins by linear EUS has not been described. This review paper describes the normal EUS anatomy of hepatic veins and a standard technique for visualization of hepatic veins from four stations. With practice an imaging of all the hepatic veins is possible from four stations. The imaging from fundus of stomach is the easiest and most convenient method of imaging of hepatic veins. EUS of hepatic vein and the tributaries is an operator dependent technique and in expert hands may give a mapping comparable to computed tomographic and magnetic resonance imaging. EUS of hepatic veins can help in identification of individual sectors and segments of liver. EUS guided interventions involving hepatic veins may require approach from different stations.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut 25001, Uttar Pradesh, India
| | - Piyush Somani
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut 25001, Uttar Pradesh, India
- Department of Gastroenterology, Thumbay Hospital, Dubai 415555, United Arab Emirates
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19
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Müssle B, Zühlke L, Wierick A, Sturm D, Grählert X, Distler M, Rahbari NN, Weitz J, Welsch T. Pancreatoduodenectomy with or without prophylactic falciform ligament wrap around the gastroduodenal artery stump for prevention of pancreatectomy hemorrhage. Trials 2018; 19:222. [PMID: 29650056 PMCID: PMC5898061 DOI: 10.1186/s13063-018-2580-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/27/2018] [Indexed: 02/06/2023] Open
Abstract
Background The purpose of this study is to evaluate whether wrapping of the pedicled falciform ligamentum flap around the gastroduodenal artery (GDA) stump/hepatic artery can significantly decrease the incidence of erosion hemorrhage after pancreatoduodenectomy (PD). Methods/design This is a randomized controlled multicenter trial involving 400 patients undergoing PD. Patients will be randomized into two groups. The intervention group consists of 200 patients with a prophylactic wrapping of the GDA stump using the pedicled falciform ligament. The control group consists of 200 patients without the wrap. The primary endpoint is the rate of postoperative erosion hemorrhage of the GDA stump or hepatic artery within 3 months. The secondary endpoints are postpancreatectomy hemorrhage stratified according to the texture of the pancreas, postoperative pancreatic fistula (POPF), postoperative rate of therapeutic interventions, morbidity, and mortality. Discussion Only few retrospective studies investigated the effectiveness of a falciform ligament wrap around the GDA for prevention of erosion hemorrhage. Erosion hemorrhage occurs in up to 6–9% of cases after PD and is most frequently evoked by a POPF. Erosion hemorrhage is associated with a remarkable mortality of over 30%. The rate of hemorrhage after performing the wrap is reported to be low. However, there exist no prospectively controlled data to support its general use. Therefore, the presented randomized controlled trial will provide clinically relevant evidence of the effectiveness of the wrap with statistical significance. Trial registration clinicaltrials.gov, NCT02588066; Registered on 27 October 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2580-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Müssle
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Leonie Zühlke
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Ann Wierick
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Dorothée Sturm
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Xina Grählert
- Coordination Centre for Clinical Trials, Faculty of Medicine Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Nuh N Rahbari
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Thilo Welsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany.
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20
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Shao Y, Yan S, Zhang QY, Shen Y, Zhang M, Wang WL, Zheng SS. Autologous falciform ligament graft as A substitute for mesentericoportal vein reconstruction in pancreaticoduodenectomy. Int J Surg 2018; 53:159-162. [PMID: 29581044 DOI: 10.1016/j.ijsu.2018.03.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/23/2018] [Accepted: 03/18/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the falciform ligament as an autologous substitute for mesentericoportal vein reconstruction during pancreaticoduodenectomy. BACKGROUND Mesentericoportal vein reconstruction was needed in some certain cases during pancreaticoduodenectomy, and a rapidly available substitute was required. METHODS The falciform ligament was used as an autologous substitute during pancreaticoduodenectomy in 6 patients between June 2016 and May 2017. Anticoagulation was not performed at any stage and venous patency was estimated by Color-Doppler ultrasonography and contrast-enhanced computed tomography. RESULTS 6 patients underwent vascular resection during pancreaticoduodenectomy for malignant tumors. The falciform ligament graft, with a mean length of 26 mm (10-40), was immediately harvested and used as a lateral patch for reconstruction of the mesentericoportal vein (n = 6). Severe morbidity included Clavien grade-III complications occurred in 1(16.7%) patients but there was no graft-related complications. Histological vascular invasion was present in all the patients (n = 6, 100%), and all had an R0 resection (100%). All venous reconstructions were patent (100%) after a mean follow-up of 12 (6-16) months. CONCLUSIONS An autologous falciform ligament graft can be safely used as a lateral substitute for mesentericoportal vein reconstruction during pancreaticoduodenectomy; this could help improve the radical resection rate of malignant tumors when oncologically required.
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Affiliation(s)
- Yi Shao
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Sheng Yan
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
| | - Qi-Yi Zhang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yan Shen
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Min Zhang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Wei-Lin Wang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Shu-Sen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
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21
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Strobel F, Schirg E, Schlaud M, Tschernig T. Massa adiposa ligamenti falciformis or anterior abdominal fat pad - Its dimension and relation to body weight. Ann Anat 2017; 216:100-102. [PMID: 29288705 DOI: 10.1016/j.aanat.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
Abstract
The anterior abdominal fat pad is associated with the falciform ligament in the upper middle/right abdomen and is frequently seen there in diagnostic imaging. It varies greatly in size and has often been described as an incidental finding in adults and has hitherto rarely been regarded as being illness-relevant. The aim of this study has been to assess whether the dimension of the corpus adiposum may be associated with body mass index. Ultrasound findings of 26 patients from birth until adolescence were analyzed for this purpose. In addition, an example from a recent dissection course has been included. The structure is constantly found with its smallest dimension in newborns, with a slight increase in infancy. The average dimensions were 7.6 by 3.5 by 0.7cm. The cubic volume correlated with age, weight and body mass index, whereas the latter association was strongest. Our data suggest that routinely determined dimension of falciform fat may be a surrogate parameter of relative body weight in childhood.
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Affiliation(s)
- Friedemann Strobel
- Institute of Anatomy and Cell Biology, Saarland University, Kirrberger Strasse, 66424 Homburg/Saar, Germany
| | - Eckart Schirg
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Martin Schlaud
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany
| | - Thomas Tschernig
- Institute of Anatomy and Cell Biology, Saarland University, Kirrberger Strasse, 66424 Homburg/Saar, Germany.
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22
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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 Port J Gastroenterol 2017; 25:179-183. [PMID: 29998163 DOI: 10.1159/000484528] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Zhiying Y, Haidong T, Xiaolei L, Yongliang S, Shuang S, Liguo L, Li X, Atyah M. The falciform ligament as a graft for portal-superior mesenteric vein reconstruction in pancreatectomy. J Surg Res 2017; 218:226-231. [PMID: 28985853 DOI: 10.1016/j.jss.2017.05.090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/30/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Tumor invasion or adherence to the portal vein-superior mesenteric vein (PV/SMV) may be encountered during pancreatic surgery. In such cases, venous resection and reconstruction might be required for complete resection of the tumor. We report an innovative technique in which the graft for PV/SMV reconstruction was made with the falciform ligament. METHODS Between May 2011 and July 2016, PV/SMV reconstruction with a falciform ligament graft was performed in 10 cases during pancreatectomy. Among these cases, including six cases with a patch graft and four cases with a conduit graft. Retrospective reviews of medical records and radiologic studies were performed. RESULTS Ten patients with pancreatobiliary cancer underwent en bloc tumor resection with concurrent PV/SMV resection and reconstruction with a falciform ligament graft. There were six males and four females, and the mean age was 65.3 ± 9.4 (48-80) y. Using Doppler ultrasound examination, all 10 grafts were shown to be patent at postoperative 2 wk. However, occlusion was found in one case with conduit graft and stenosis in the other three cases with conduit graft using enhanced computed tomography at postoperative 2 mo. Complete patency was shown in three of six cases with patch graft and stenosis in the other three cases at 2 mo after the operation. Although occlusion or stenosis of the grafts was observed, no severe adverse events occurred, and normal liver function was discovered in all 10 cases at postoperative 2 mo. CONCLUSIONS Falciform ligament grafts might be considered for reconstruction of PV/SMV in the absence of appropriate vascular grafts.
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Affiliation(s)
- Yang Zhiying
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China.
| | - Tan Haidong
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Liu Xiaolei
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Sun Yongliang
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Si Shuang
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Liu Liguo
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xu Li
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Manar Atyah
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
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Müssle B, Wierick A, Distler M, Weitz J, Welsch T. Falciform ligament wrap for prevention of gastroduodenal artery bleed after pancreatoduodenectomy. J Surg Res 2016; 207:215-222. [PMID: 27979479 DOI: 10.1016/j.jss.2016.08.087] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/07/2016] [Accepted: 08/26/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The present study aims to assess the effectiveness and current evidence of a pedicled falciform ligament wrap around the gastroduodenal artery stump for prevention of erosion hemorrhage after pancreatoduodenectomy (PD). METHODS Retrospective data were pooled for meta-analysis. At the own center, patients who underwent PD between 2012 and 2015 were retrospectively analyzed based on the intraoperative performance of the wrap. A systematic literature review and meta-analysis was performed that combined the published and the obtained original data. The following databases were searched: Medline, Embase, Web of Science, and the Cochrane Library. RESULTS At the own center, a falciform ligament wrap was performed in 39 of 196 PDs (20%). The wrap group contained more ampullary neoplasms, but the pancreatic fistula rate was not significantly different from the nonwrap group (28% versus 32%). In median, erosion hemorrhage occurred after 21.5 d, and it was lethal in 39% of the patients. Its incidence was not significantly lower in the wrap group (incidence: 7.7% versus 9.6% in the nonwrap group). The systematic literature search yielded four retrospective studies with a high risk of bias; only one study was controlled. When the five data sets of published and own cases with a falciform ligament wrap were pooled, the incidence of erosion hemorrhage was 5 of 533 cases (0.9%) compared with 24 of 297 cases (8.1%) without the wrap. CONCLUSIONS The reported incidence of erosion hemorrhage after the falciform ligament wrap is low, but there are still insufficient controlled data to support its general use.
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Affiliation(s)
- Benjamin Müssle
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ann Wierick
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thilo Welsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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25
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Macina S, Testa T, Losacco C. Congenital internal hernia through defect in the falciform ligament in adult: A case report and review of the literature. Int J Surg Case Rep 2016; 26:104-7. [PMID: 27478967 PMCID: PMC5013291 DOI: 10.1016/j.ijscr.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/01/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The incidence of occlusion syndrome caused by internal hernia is very rare, in particular when the defect is congenital discovered in adults with no previous abdominal surgery. PRESENTATION OF CASE We present a case of a 31 year-old female patient who presented with acute abdominal pain and mechanical obstruction. The patient had never undergone abdominal surgery. DISCUSSION On diagnostic laparoscopy, it was found a herniation of a loop of small bowel through a hole in the falciform ligament. The obstruction was solved by the division of part of falciform ligament without intestinal resection. CONCLUSION Internal hernia is a very uncommon pathology, most often discovered in pediatric age because of congenital abnormalities, it must be included in the differential diagnosis in adults. Preoperative diagnosis is difficult. The diagnostic laparoscopic approach has shown to be the best.
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Affiliation(s)
- Simona Macina
- University of study of Genoa (Italy) IRCCS, Largo Benzi 10, 16132 Genova, Italy.
| | - Tommaso Testa
- University of study of Genoa (Italy) IRCCS, Largo Benzi 10, 16132 Genova, Italy.
| | - Caterina Losacco
- University of study of Genoa (Italy) IRCCS, Largo Benzi 10, 16132 Genova, Italy.
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Kim JH, Jung YJ, Chang CH. Laparoscopic Treatment of Ventriculoperitoneal Shunt Complication Caused by Distal Catheter Isolation Inside the Falciform Ligament. World Neurosurg 2016; 90:707.e1-707.e4. [PMID: 27001241 DOI: 10.1016/j.wneu.2016.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND A ventriculoperitoneal shunt is a widely recognized treatment that we use to treat hydrocephalus. In one's lifetime, there is a high possibility of being diagnosed with shunt dysfunction. Occasionally, complications caused by the distal catheter located in the intra-abdominal cavity may occur. CASE DESCRIPTION In this case, after undergoing shunt surgery, the patient's distal catheter had not moved and was fixed in 1 place. Therefore, we used abdominal computed tomography and discovered the presence of a pseudocyst where the distal catheter was located. Through laparoscopic-assisted surgery performed by the department of general surgery, we discovered that the distal catheter entered into the falciform ligament and caused it to expand, creating a cyst. The fascia of the falciform ligament was dissected using a harmonic scalpel. Cerebrospinal fluid and the distal catheter were noted. Afterwards, the distal catheter was placed into the peritoneal cavity. After surgery, the patient was discharged without any complications. CONCLUSIONS Although this is an unusual circumstance, there have been reports of some cases in which the ventriculoperitoneal shunt distal catheter entered the falciform ligament. Therefore, one must pay close attention during the operation. In addition, when treatment is necessary, laparoscopic-assisted surgery might serve as an effective diagnostic and therapeutic modality.
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Affiliation(s)
- Jong-Hoon Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Young-Jin Jung
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Chul-Hoon Chang
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea.
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Griffin AS, Schaefer NR, Jeyarajan E, Cross T. Concurrent Spigelian hernia and falciform ligament hernia in a 67-year-old female. Int J Surg Case Rep 2015; 13:27-9. [PMID: 26083483 DOI: 10.1016/j.ijscr.2015.05.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/29/2015] [Accepted: 05/31/2015] [Indexed: 11/25/2022] Open
Abstract
We present a case of a concurrent Spigelian hernia and internal hernia through the falciform ligament. We discuss the clinical presentation and management of this case. We suggest methods to decrease mortality from internal hernias such as a raised awareness and a laparoscopic approach for adequate internal examination of the abdominal contents.
Introduction Internal abdominal hernias account for 1% of all hernias but 5.8% of all bowel obstructions and hence are of significant clinical importance. Similarly Spigelian hernias account for only 0.12–2% of all abdominal wall hernias. Case presentation We present and discuss the management of a case that presented with concurrent falciform ligament internal abdominal hernia and Spigelian hernia. We believe this is the first reported case of such an occurrence in the literature. Conclusion Due to the advancements in computer topography (CT) imaging many internal and Spigelian hernias are diagnosed pre-operatively though these scan are not always available or indicated in cases of suspected small bowel obstruction. Due to the high mortality rate of undiagnosed internal hernias a high clinical suspicion must be maintained. The authors recommend laparoscopic trans-abdominal repair of Spigelian hernias in order to examine the abdominal contents and exclude rare, though potentially serious internal hernias.
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Soni V, Valse PD, Vyas S. Colonic Atresia due to Internal Herniation through the Falciform Ligament Defect: A Case Report. J Neonatal Surg 2014; 3:21. [PMID: 26023492 PMCID: PMC4420329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 03/02/2014] [Indexed: 11/04/2022] Open
Abstract
Colonic atresia is the rarest outcome of all gastrointestinal type of internal hernia. We report a case of neonate with atresia of the transverse colon caused by herniation of the transverse colon through a defect in falciform-ligament.
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Affiliation(s)
- Varsha Soni
- Department of Pediatric Surgery, J.L.N. Medical College, Ajmer
| | - Prakash D. Valse
- Department of Surgical Gastroenterology, J.L.N. Medical College, Ajmer
| | - Sameer Vyas
- Department of General Surgery, J.L.N. Medical College, Ajmer
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Sadhu S, Pattari SK, Sarkar S, Dubey SK, Roy MK. Perivascular epithelioid cell tumor (PEComa) of falciform ligament - an extremely rare tumor. Indian J Surg 2008; 70:200-2. [PMID: 23133059 DOI: 10.1007/s12262-008-0055-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 06/27/2008] [Indexed: 11/27/2022] Open
Abstract
Primary tumor of falciform ligament is exceedingly uncommon. So far, seven cases of Perivascular Epithelioid Cell tumor (PECom), a recently described histological entity with characteristic perivascular tumor cell arrangement and expression of muscle and melanocytic marker by the cells, have been reported in literature. Here, we report a case of PEComa of falciform ligament, which presented with a huge abdominal lump. Pre-surgical CT scan of abdomen was uninformative regarding the nature and organ of origin of the tumor. On laparotomy, it was surprisingly found to arise from the falciform ligament, and this was easily removed. Histopathological diagnosis confirmed PEComa. There was no recurrence of disease after two years of follow up.
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Affiliation(s)
- Sagar Sadhu
- Rabindranath Tagore International Institute of Cardiac Sciences, 124 Mukundapur, Kolkata, West Bengal India
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