Falciform Ligament Hernia after Laparoscopic Cholecystectomy: A Rare Case and Review of the Literature

Abstract

The occurrence of an internal hernia through a congenital or iatrogenic defect in the falciform ligament is extremely rare. In the era of minimally invasive surgery, we present an unusual case of small bowel obstruction after laparoscopic cholecystectomy. An 85-year-old white male presented to the emergency room 2 weeks after an uneventful cholecystectomy and complaining of a colicky, nonradiating right upper quadrant abdominal pain. Hydroxyiminodiacetic acid (HIDA) scan and endoscopic retrograde cholangiopancreatography (ERCP) performed revealed an open ductal system. Abdominal computed tomography (CT) scan was suggestive of a high-grade small bowel obstruction. Exploratory laparotomy revealed a herniated loop of distal ileum, passing from right to left through a defect in the falciform ligament created by the subxyphoid trochar. The surgeon should consider dividing the inferior leaf of the free edge of the falciform ligament, including the round ligament, should an aperture be created during laparoscopic port placement.

Congenital internal hernia through defect in the falciform ligament in adult: A case report and review of the literature

“…The first case of falciform hernia was described in 1929 and each decades is characterized by an increasing number of new cases, as such as there is an ever-increasing rate of cases done laparoscopically. This evidence suggests logically the association between the two events [10] , [15] , [16] . In the above-described case, the defect did not appear to be iatrogenic because the patient had never undergone abdominal surgical procedures.…”

“…Most of the time this defect is discovered during pediatric age. Instead in adult the most frequent cause of abdominal hernia is iatrogenic defect created post laparoscopic surgery (in particular cholecystectomy, bariatric and gastro-esophagus procedures) during insertion of the port cannula [10] , [11] . The first case of falciform hernia was described in 1929 and each decades is characterized by an increasing number of new cases, as such as there is an ever-increasing rate of cases done laparoscopically.…”

Infarcted ligamentum teres hepatis lipoma mimicking acute abdomen in a female patient: a case report and mini-review of the literature

“…Falciform ligament is a double fold of peritoneum that contains ligamentum teres, umbilical vein and fat tissue [ 1 ]. Pathologies of the falciform and round ligament include internal hernias through congenital or acquired (iatrogenic or traumatic) defects, congenital, infectious, neoplastic or traumatic cysts, inflammatory processes, tumors and tumor-like conditions and intra-abdominal focal fat infarction [ 2–5 ]. Although rare, some of these conditions may induce acute abdominal pain, such as isolated abscess, gangrene, necrosis or hematoma of the ligaments and torsion of the fatty appendage [ 6–8 ].…”

“…Falciform ligament is a double fold of peritoneum that marks the anatomical division of the two hepatic lobes. Pathological conditions of these two ligaments constitute a rare entity [ 2–5 ]. Even though lipomas are very common mesenchymal tumors, only few cases have been reported in the region of ligamentum teres.…”

The falciform ligament and the ligamentum teres: friend or foe

“…With the advent of laparoscopic surgery, more recent cases of internal hernias have occurred as a result of iatrogenic defects created in the falciform caused by the placement of laparoscopic trocars 3 …”