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10.5005/jp-journals-10033-1343
A Rare Case of Falciform Ligament Abscess with Unknown Etiology
CASE REPORT

A Rare Case of Falciform Ligament Abscess with

Unknown Etiology

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1 Vimal K Jain, Ashishkumar G Hadiyal, Shalit A Jolly, Vivek Maurya
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ABSTRACT The incidence of the falciform ligament is very rare.
The incidence of a falciform ligament is very rare. Because of Only a few cases have been reported till date. The patho-
the rarity of the condition and sparsity of available literature, physiology of abscess formation in falciform ligament is
it’s very difficult to diagnose this condition preoperatively. In not very well understood. Preoperatively diagnosis of
this case, a 65-year-old lady had presented with pain in epigas- this condition is difficult. A case of falciform ligament
trium and vomitings for 3 days. All blood investigations were
normal except serum Alkaline phosphatase (ALP) and serum abscess misdiagnosed as acute cholecystitis in our hos-
gamma-glutamyl transferase (GGT) which were 141 IU/L and pital is reported here.
275 U/L respectively. USG revealed only chronic cholecystitis.
On diagnostic laparoscopy, falciform ligament abscess was Clinical Case Presentation
detected which was adequately drained. The patient responded
well with the drainage without recurrence till date. Laparoscopic A female patient aged 65 years admitted in Mata Chanan
cholecystectomy was also done in the same sitting. Devi hospital with a complaint of pain in epigastrium
Keywords: Cholecystitis, Diagnostic laparoscopy, Falciform and vomitings for 2 to 3 days.
ligament abscess. The pain was severe, sudden in onset, constant,
List of Used Abbreviations: ALP–Alkaline phosphatase, radiating to back and not related to the meal—no
CECT–Contrast enhanced computed tomography, DNB–Dip- previous history of such type of pain. There was no
lomates of national board, ECG–Electrocardiography, GGT– history of fever, jaundice, breathing difficulty or any
Gamma-glutamyl transferase, PAC–Pre-anesthetic clearance,
RBS–Random blood sugar, SGOT–Serum glutamic oxaloacetic trauma to chest and abdomen. There was no history
transaminase, SGPT–Serum glutamic-pyruvic transaminase, of surgery in the past. The patient was nonalcoholic
USG–Ultrasonography and not a diabetic or hypertensive and had no other
How to cite this article: Jain VK, Hadiyal AG, Jolly SA, Maurya V. major illnesses.
A Rare Case of Falciform Ligament Abscess with unknown The patient was afebrile, pulse rate was 82/minute
Etiology. World J Lap Surg 2018;11(2):103-105. and blood pressure was 118/74 mm of Hg. The abdomen
Source of support: Nil was tender in the epigastrium and right hypochondrium.
There was no palpable mass. As per history and clinical
Conflict of interest: None
examination, a provisional diagnosis of acute cholecys-
titis was made.
INTRODUCTION
Complete blood count, RBS, serum electrolytes,
The falciform ligament helps in holding the liver in place urea, creatinine, amylase, lipase, bilirubin, SGOT, SGPT,
by attaching it to the anterior abdominal wall. It is com- chest X-ray, ECG were normal. Serum ALP was mildly
posed of two layers of peritoneum closely united together raised(141 IU/L) GGT was raised (275 U/L). USG find-
which might provide potential space for infection. Its free ings were suggestive of chronic cholecystitis with cho-
edge contains the round ligament (ligamentum teres) lelithiasis.
and the paraumbilical veins between its layers. This Provision diagnosis of acute cholecystitis was made
sickle-shaped ligament (Latin-falciform means sickle) is while USG findings were not in favor. After PAC patient
remnant of the fetal umbilical vein and derivative of the underwent diagnostic laparoscopy. On operation, the
embryonic ventral mesentery. falciform ligament was bulging and was firm in consis-
tency (Fig. 1). On aspiration, the purulent material came
out (Fig. 2). All purulent material was drained by giving
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1 Senior Consultant Surgeon, Junior Consultant Surgeon DNB a cruciate incision and wound was irrigated adequately
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Trainee with normal saline (Fig. 3). Laparoscopic cholecystec-
1-4 Department of General Surgery, Mata Chanan Devi Hospital, tomy was done. HPE confirmed the diagnosis of chronic
Janakpuri, New Delhi, India cholecystitis with cholelithiasis. The patient responded
Corresponding Author: Ashishkumar G Hadiyal, DNB Trainee, well. She was discharged on after 2 days. The patient
Department of General Surgery, Mata Chanan Devi Hospital, was followed up for 60 days. There were no symptoms
Janakpuri, New Delhi, India, e-mail: ashish_hadiyal3@yahoo.com
suggestive of recurrence.
World Journal of Laparoscopic Surgery, May-August 2018;11(2):103-105 103