A Rare and Unusual Case of Falciform Ligament Hernia and a Review of the Literature

Akram Alashari, MD, R Kimball, MD, I Daoud, MD, FACS

Division of Minimally Invasive Surgery St. Francis Hospital and Medical Center, Hartford, CT; University of Connecticut Health Center, Farmington, CT

Introduction: Internal abdominal hernias develop when one or more viscera extrude through an intraperitoneal orifice but remain within the peritoneal cavity. Internal hernia through an aperture in the falciform ligament is a rare and unusual cause of internal hernia, accounting for about 0.2% of internal hernias. Most case reports in the literature describe a patient who has the acute onset of abdominal pain with obstructive symptoms who is found to have incarcerated and/or strangulated bowel intaoperatively.

Methods: We present a case report of a 79-year-old male who presented electively for repair of a ventral (incisional) hernia. Upon introduction of the laparoscope, it was noted that there was a loop of small bowel herniated through a defect in the falciform ligament. The bowel was then reduced, the falciform ligament was mobilized, and the ventral hernia defect was repaired with mesh.

Results: Our patient did well intraoperative and immediately postoperatively and did not require a bowel resection or conversion to an open laparotomy. Other results of reports in the literature varied from an uncomplicated course to patient demise, largely related to the time of presentation/intervention and intraoperative findings.

Conclusions: Herniation of small bowel through a defect within the falciform ligament is a rare subtype of internal hernias. Defects of the falciform ligament can be congenital or acquired. There are case reports in the literature of this entity occurring at any age from the neonatal period to the geriatric population. The presence of this aperture creates the potential for a segment of bowel to protrude through it with subsequent strangulation. With the advent of increasing use of laparoscopy, there is likely to be an increased incidence of recognition of this entity, especially if a trocar inadvertently traverses the ligament. It is now recommended that if a defect is created in the falciform ligament during surgery, it should be divided as to not allow for the potential of subsequent internal herniation.

Session: Poster Presentation

Program Number: P299