US and CT diagnosis of a twisted lipomatous appendage of the falciform ligament

Abstract

Pathologic conditions of the falciform ligament leading to surgical intervention are extremely uncommon. We report a case of twisted lipomatous appendage of this ligament, demonstrated by US and CT. To our knowledge, there have been no previous reports of this entity. The extraperitoneal nature of the lesion was found by realtime sonography, but CT only was able to characterize its lipomatous nature and relationship with the falciform ligament. This lesion should be considered in the differential diagnosis of intra-abdominal focal fat infarction (IFFI), a recent vocable essentially regrouping infarction of omentum and epiploic appendages.

Appendagitis of the lesser omentum – an uncommon cause of acute abdominal pain

“…This term was first introduced by van Breda Vriesmann et al in 1999 and regroups acute appendagitis and infarction of the greater omentum. The common denominator is a focal fatty and inflammatory tissue necrosis differing only in their anatomical location and dimensions [1][2][3][4][5][6][7][8][9]. The lesser omentum is a peritoneal reflection connecting the lesser gastric curvature and the proximal duodenum with the liver.…”

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

“…Their contention was that the necrosed and gangrenous tissue had to be removed, even if the diagnosis of IFFI was correct. However, we feel that, as enunciated by Coulier et al [5] , non-contrast CT with MPR can unequivocally diagnose the IFFI involving appendage of falciform ligament and conservative treatment can be instituted for all the cases instead of proceeding directly to surgery. Better awareness of this condition among the radiologists and the surgeons can be a good step in that direction.…”

“…Usually, conservative treatment is adequate, but a few of the reported cases have been operated, primarily due to lesser awareness about the condition and its usually self-limiting nature [5,6,9] . Another reason for laparotomy was due to the possibility of necrosis and gangrene as seen in some reports [2] .…”

“…Other pathologies of falciform ligament include internal hernia through congenital defects, congenital/infective/neoplastic cysts, and lipomas [5] . Sometimes, there may be isolated necrosis of the falciform ligament with no other findings [2] .…”

A new case of intraperitoneal fat focal infarction (IFFI) of the lesser omentum

“…More recently, case reports have described much more rare types of IFFI concerning torsion of a lipomatous appendage of the falciform ligament and infarction of the lesser omentum [2,3].…”