Abstract
BackgroundNecrosis of the falciform and round ligaments is extremely rare, thus making the diagnosis challenging. It is often misdiagnosed as gallbladder pathology due to the presenting symptoms. Due to the rarity of this pathology, there is limited literature available.Case presentationA 53-year-old white man presented to our hospital with signs and symptoms of gallbladder pain but turned out to have the rare entity of necrosis of the falciform and round ligaments. An extensive review of the world literature was performed using PubMed. Manual cross-referencing of reference lists was performed to obtain all available articles. The personal operative log of the senior author was also searched to reveal one additional case. Statistical analysis was descriptive only, given the small number of reported cases. Thirty-nine articles were found, among which forty-three case were identified, and one additional case was extracted from the operative log of the senior author. Unlike previous reports, we found that isolated inflammation and necrosis of the ligaments occurs at nearly the same frequency in both men and women, not predominantly in women as previously reported in smaller series. The mean age at presentation was 59.5 years old, and cases were typically initially diagnosed as gallbladder pathology, most commonly acute cholecystitis. Computed tomography more frequently than ultrasound revealed the falciform and round-ligament pathology.ConclusionsIsolated falciform and round-ligament inflammation and necrosis is a rare condition that is difficult to diagnose because it can present mimicking a wide variety of intra-abdominal pathologies, particularly gallbladder pathologies. It is often best treated by laparoscopic resection. Unlike prior reports, our review of the literature, which is the largest that we know of to date, shows that males and females are equally affected. Greater awareness of this entity will aid in future diagnosis.
Highlights
The falciform ligament is a triangular, or falciform, fold of peritoneum stretching between the umbilical fissure of the liver and the anterior abdominal wall
Isolated falciform and round-ligament inflammation and necrosis is a rare condition that is difficult to diagnose because it can present mimicking a wide variety of intra-abdominal pathologies, gallbladder pathologies
It is often best treated by laparoscopic resection
Summary
Inflammation and necrosis of the falciform and round ligaments is a very uncommon entity with limited literature available. Some pearls can be gleaned from our case report and literature review. The mean age of presentation is 60 years old, and women and men are affected. Patients typically present with symptoms mimicking gallbladder disease, such as acute cholecystitis or symptomatic cholelithiasis. In cases of right upper quadrant or epigastric tenderness or peritonitis without positive findings of gallbladder inflammation or stones, or free fluid or gas, surgeons should be more suspicious of alternative pathology, such as round/falciform ligamentitis. CT is preferred to US to make the diagnosis. Surgical management is the definitive treatment, and a minimally invasive approach is preferred when feasible
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