Internal herniation through a defect in the falciform ligament: a case report and review of the world literature

Abstract

Hernia through the falciform ligament accounts for 0.2% of internal hernias. A congenital etiology for these defects is probable. Contributing risk factors include visceral displacement into the upper abdomen and excessive visceral mobility. Patients present most commonly with symptoms of bowel obstruction, Chilaiditi Syndrome on abdominal roentgenograms and abdominal computed tomography may aid in diagnosis. Treatment consists of eliminating the hernia defect by suture ligation and division of the fatciform and ligamentum teres as well as surgical management of secondary bowel ischemia if present. The existence of 'parafalciform hernia' and 'bowel stringing falciform obstruction' must also be recognized as possible etiologies for visceral obstruction or strangulation caused by the fatciform ligament.

Intestinal obstruction in case of internal hernia through congenital defect in falciform ligament in adult

“…The incidence of intestinal obstruction in case of internal hernia ranges from 2-4%, from which through falciform ligament defect are 0.2%. 5 The cause of defect may be congenital (in case of malformation and incomplete development of falciform ligament) or acquired (iatrogenic defect created by port insertion for laproscopic procedures, commonly for bariatric, cholecystectomy). 6 In this patient as there is no previous operative history, defect is termed congenital.…”

“…Literature shows that 0.2% hernia occurs through defect in falciform ligament. 5 About 35 cases have been reported so far.…”

Hernie interne du ligament falciforme: une cause rare d'occlusion intestinale

“…Dans la majorité des cas, le diagnostic est fait à l'occasion d'un épisode hyperalgique aigu ou d'un syndrome occlusif comme dans notre observation. Le diagnostic doit être évoqué devant le jeune âge, l'absence d'antécédents de chirurgie abdominale ou de processus infectieux intrapéritonéal et la présence de niveaux hydro-aériques dans l'hypocondre droit [2]. La tomodensitométrie abdominale, non réalisée chez notre malade, est l'examen d'imagerie de référence devant un tableau d'occlusion intestinale aiguë sur un abdomen "vierge" [1, 6].…”

“…La hernie à travers le ligament falciforme est exceptionnelle et de diagnostic souvent peropératoire [1, 2]. Actuellement la tomodensitométrie abdominale pratiquée en urgence, peut aider au diagnostic en préopératoire et permet de guider l'attitude thérapeutique.…”

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

“…Furthermore, if the bowel is strangulated, there is a significant risk of morbidity and mortality attributed to delayed diagnosis. 2 Herniation through the falciform ligament is extremely rare and accounts for 0.2% of all internal hernias. falciform ligament.…”