Strangulated Falciform Hernia

Abstract

Internal hernias are rare, and a delayed diagnosis can lead to dangerous complications. A 75-year-old male with no previous surgical history presented with right upper abdominal pain and vomiting. On examination, he had guarding in the right hypochondrium with a positive Murphy's sign. However, ultrasonography of the gall bladder was normal with dilated bowel loops. Contrast-enhanced CT (CECT) revealed a falciform hernia with evidence of obstruction. Segmental resection of the gangrenous ileum was done with a double-barrel stoma. Later on, stoma reversal was also done with no complications.

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

“…As was the case with our patient, the symptoms of a falciform ligament hernia are often nonspecific, and preoperative diagnosis is challenging, with failure to consider an internal herniation and delayed treatment resulting in worse patient outcomes. Of note, one symptom that has been attributed to a falciform ligament hernia is pain relief in the knee-chest position and exacerbation in the supine position [ 3 ].…”

“…In response to the increasing incidence of falciform ligament hernias in association with the rise in laparoscopic surgical approaches, several risk reduction strategies have been proposed. Internal herniation may be prevented by placing the subxiphoid trocar just to the right of the midline during laparoscopic cholecystectomy [ 3 ]. Removal of the subxiphoid port under vision before the desufflation of the pneumoperitoneum can prevent the postoperative chances of herniation [ 3 ].…”

“…Internal herniation may be prevented by placing the subxiphoid trocar just to the right of the midline during laparoscopic cholecystectomy [ 3 ]. Removal of the subxiphoid port under vision before the desufflation of the pneumoperitoneum can prevent the postoperative chances of herniation [ 3 ]. If an aperture is created in the falciform ligament during laparoscopic surgery, division of the falciform ligament, including the round ligament, may prevent future falciform ligament herniation [ 3 ].…”

Falciform hernia following gastric bypass surgery case report

“…A falciform ligament hernia is a rare type of internal hernia where abdominal organs go through a congenital or iatrogenic defect of the falciform ligament. Falciform ligament hernias are reported to comprise 0.2% of internal hernias and are often related with laparoscopic surgery [11,12]. Falciform ligament hernias often contain the small bowel.…”

“…Falciform defects can be congenital or traumatic. Most traumatic injuries to the falciform ligament are associated with trochar placement during laparoscopic surgery [11]. Bariatric surgery often involves placement of trocars in the subxiphoid position and this can injure the falciform ligament [18].…”