Torsion of Fatty Appendage of Falciform Ligament: Acute Abdomen in a Child

Abstract

Torsion of the fatty appendage of the falciform ligament is an extremely rare condition that leads to severe abdominal pain and raised inflammatory markers. It can be recognised on ultrasound or CT scan. The pathophysiology is the same as that involved in the more common torsion and/or infarction of the greater omentum or epiploic appendages. The condition is best managed conservatively with anti-inflammatory analgesia, and the early recognition of this type of torsion may prevent unnecessary operative intervention to look for a source of abdominal pain. There have been five reported adult cases of a torted fatty appendage of the falciform ligament identified on ultrasound and CT scan, but no paediatric cases. We report a case of torsion of the fatty appendage of the falciform ligament in a ten-year-old boy and describe its imaging characteristics on CT scan.

Unusual Cause of Epigastric Pain: Intra-Abdominal Focal Fat Infarction Involving Appendage of Falciform Ligament - Case Report and Review of Literature

“…Of these, torsion and infarction of fatty appendage of the falciform ligament is exceedingly rare with less than 20 cases documented with imaging studies so far ( Table 1 ). There have been very few cases reported before 1977 (based on surgical findings without use of imaging modalities) [1] . The falciform ligament is a double-layered peritoneal fold which extends from the superior edge of the liver to the inferior border of the diaphragm and anatomically divides the right and left lobes of liver.…”

“…Fatty appendages of the falciform ligament may very rarely undergo torsion, leading to fat infarction [1,2] . This type of torsion or infarction, which occurs more commonly in the epiploic appendages or greater omentum and rarely involving the perigastric ligaments (gastrohepatic, gastrosplenic, and falciform), is grouped together as intra-abdominal focal fat infarction (IFFI) [3] .…”

Diagnosis of a sonographically negative extensive defect of the lig.falciforme hepatis

“…falciforme hepatis на мембранозную и жировую части [27], возможно два варианта (группы) патологических изменений связки. Первой группой (А) будут изменения мембранозной части (ее дефекты), второй группой (В) -изменения жировой части (перекрут ее части с некрозом) [26,29,32]. Возможны сочетанные изменения (С): при травматических повреждениях передней брюшной стенки и сопутствующей травме lig.…”

“…falciforme hepatis также характеризуется особенностями клинического течения [29]. Инструментальные методы диагностики этих состояний включают КТ [26,31], УЗИ [21,24]. Однако в отличие от патологических изменений жировой части lig.…”

Fatty necrosis of falciform ligament due to torsion mimics falciform ligament cyst on MRI

“…The European Research Journal 2018;4(4):448-451 he falciform ligament is a double layer of peritoneum that goes from the upper and anterior surfaces of the liver to the lower surface of the diaphragm and the back of the linea alba. Its line of attachment divides the liver into left and right lobes [1]. It attaches the liver to the remnants of the umbilical veins.…”