[Idiopathic segmental fatty tissue necrosis of the ligamentum teres hepatis. Variation on a theme...]

A rare cause of acute abdomen: an isolated falciform ligament necrosis

The falciform ligament is one of the anatomical structures which attach the liver to the diaphragm and anterior abdominal wall. Primary falciform ligament is very rare. In this article, we present a case of an isolated falciform ligament necrosis, a rare primary pathology of the falciform ligament, who was admitted with acute abdomen.

CASE PRESENTATION

A 64-year-old female patient was admitted with the complaints of pain. Laboratory test results showed a leukocyte count of 17,000/mm(3). Imaging studies demonstrated intra-abdominal reactionary fluid along with a heterogeneous mass localized in the falciform ligament. Exploratory laparotomy revealed a necrotic mass of the falciform ligament. No other pathology responsible for falciform ligament necrosis was found. We believe that falciform ligament necrosis should be considered a preliminary diagnosis, if any ligament abnormality, tumor, intraligament air density, or the presence of reactionary fluid surrounding the ligament is detected through abdominal imaging studies.

Acute appendagitis of the ligamentum teres hepatis: clinical, ultrasound, and computed tomographic findings

PURPOSE

To describe the clinical, ultrasound (US), and CT findings in three patients with acute appendagitis of the ligamentum teres hepatis.

METHODS

A retrospective search of cases over a 4-year period was performed and yielded three patients with acute appendagitis of the ligamentum teres hepatis. The diagnosis was confirmed by US, CT, and clinical follow-up in all three cases. We retrospectively noted the laboratory data, clinical findings, and presumptive clinical diagnosis and describe the US and CT findings.

RESULTS

All three patients presented with severe, circumscribed epigastric pain without other symptoms. The complex reactive protein was not elevated or only mildly elevated. At the spot of maximum pain, US and CT showed all signs of an acute appendagitis; however, the pain was not close to colon, but close to the teres ligament. Symptoms resolved within 1 to 2 weeks without therapy.

CONCLUSIONS

Acute appendagitis of the teres ligament is not as rare as previously assumed. Familiarity with the US and CT features enables a reliable diagnosis and prevents unnecessary medical or operative treatment.

First complete laparoscopic resection of a gangrenous falciform ligament

Surgical resection is the treatment of choice for patients with gangrene or an abscess of the falciform ligament. We describe the first complete laparoscopic resection of a gangrenous falciform ligament in a 44-year-old female patient with first signs and symptoms of peritonitis.

Videolaparoscopic treatment for isolated necrosis and abscess of the round ligament of the liver

A case involving abcess and necrosis of the round ligament of the liver is described. This type of case is seldom reported in medical literature. Laparaoscopy is a very useful and feasible tool for the diagnosis and treatment of such cases. The video shows an oversized round ligament with necrotic appearance partially blocked by the epiplon, gallbladder, and stomach. (This online case report contains a video.).

[Diagnostic and therapeutic management of acute abdomen in Hajah, Yemen]

We report on the results of surgical treatment in 236 patients admitted with clinical signs of acute abdomen between the 1st of January 2000 and the 31st of December 2003 at the District Hospital of Hajah in northwest Yemen. Hajah, a city 2500 m above sea level, has 60,000 inhabitants and serves an area with 800,000 inhabitants. The hospital was funded by the Saudi Arabian government and built in 1997. Data on patients with acute abdominal pain were prospectively collected and analysed according to diagnosis, age, sex, and duration of symptoms. The most frequent cause was acute appendicitis, followed by incarcerated inguinal hernia. Complicated ulcer diseases of the upper gastrointestinal tract and gynaecological disorders were also frequently diagnosed. Gunshot wounds were the most frequent trauma. Despite the limited diagnostic equipment at the Hajah District Hospital and the short duration of hospital stay, there was no fatal event during the 1-year period analysed. The management of patients with acute abdominal pain and the ability to arrive at exact diagnosis is dependent on the availability of diagnostic means such as abdominal ultrasound and CT scan. However, especially in rural countries with only rudimentary technology, far more depends on the professional training and qualification of the surgeons responsible.

MR imaging in abdominal emergencies

The use of MR imaging in the emergency setting is evolving. Clear indications include situations in need of contrast media when iodinated contrast cannot be administered or to facilitate assessments in pregnant patients and children when exposure to ionizing radiation is considered unacceptable. The availability of rapid, motion-immune sequences now makes MR imaging a feasible study in less cooperative patients extending the range of patients for whom a diagnostic study can be achieved. Capitalizing on the unique benefits of MR imaging there is optimism that MR imaging can eliminate test redundancy and impact patient care in a cost-effective manner. Further investigations are needed to identify the diagnostic algorithms for which this favorable use holds true.

Isolated Gangrene of the round and Falciform Liver Ligaments: A Rare Cause of Peritonitis: Case Report and Review of the World Literature

Isolated infection and/or gangrene of the round and falciform liver ligaments is among the rarest causes of acute abdomen. The diagnosis is based on demonstrating localized or patchy inflammatory or gangrenous changes in tike ligaments without apparent etiology. We report the case of an 18-year-old male who presented with a 24-hour history of generalized abdominal pain and distention, nausea, and vomiting. With a preoperative diagnosis of probable perforated duodenal ulcus and generalized peritonitis the patient underwent emergency surgery. Multiple patchy gangrenous areas of the round and falciform ligaments were found starting from the umbilicus up to the hepatic hilum. The ligaments were resected in toto. The patient's postoperative course was unremarkable. No apparent etiology of the condition was found. We provide the first extensive review of the world literature. Isolated infection and/or gangrene of the round and falciform liver ligaments should be suspected in patients with upper abdominal complaints when imaging studies demonstrate ligament abnormality, tumor, or fluid. Treatment is only surgical. Depending on surgeon's expertise, patient's condition, and severity and extent of disease either open or laparoscopic surgery may be performed.