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

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.

Torsion of the Falciform Ligament Diagnosed by Imaging Tests – Case Report of an Unusual Disease

“…The gold standard diagnosis is performed by computed tomography as in the case described. Computed tomography demonstrates the border sign with inflammatory tissue around the falciform planes and an image of a fatty appearance along the falciform ligament, without contrast enhancement, consistent with torsion of the falciform ligament (Maccallum et al, 2015;Bangeas et al, 2020;O'Connor et al, 2022).…”

“…Ultrasonography, which is usually the initial evaluation test due to its low cost, demonstrates a hyperechoic, oval, non-compressible image, surrounded by a peripheral hypoechoic halo, located in the region of greatest pain intensity. This finding makes the diagnosis suspect but does not differentiate the different etiologies, usually requiring a more detailed imaging exam (Maccallum et al, 2015;Bangeas et al, 2020;O'Connor et al, 2022).…”

“…The faster the diagnosis is made, the more feasible it is to treat the patient conservatively with analgesics and rest, as in the case described. However, there is the possibility of laparotomy or exploratory laparoscopy in more severe cases of pain that is refractory to conservative treatment or whose pain returns intensely after a few hours of improvement (Maccallum et al, 2015;Horak et al, 2019;Bangeas et al, 2020).…”

Hepatic falciform ligament appendagitis evaluated by ultrasound: A report of 2 cases

“…The diagnosis of infarcted ligamentum teres hepatis lipoma by MRI has only been reported in one case [8] . In case 2, MRI showed an oval mass that had a high signal on T1WI, was in contact with the hepatic round ligament, had a T2WI signal equivalent to the surrounding fatty tissue, and fat-suppressed T2WI low signal.…”