Andres Falla, MD1, Santiago Navas, MD2, Gustavo Aguirre, MD1. 1Hospital Militar Central, Bogota, 2Fundacion Cardioinfantil Bucaramanga
INTRODUCTION: Internal hernias account for a small percentage of small bowel obstruction, and the condition involves herniation of a viscus through a normal o abnormal opening within the peritoneal cavity. Paraduodenal hernias account for more than 50% of the cases. Other less common causes include transmesenteric, transomental, foramen of Winslow and paracecal hernias. Only surgical findings can confirm the diagnosis and offer adequate treatment. Here we report two unusual cases of small bowel herniation through a defect in the Falciform ligament in an male and an woman 75 and 49 years old, and a case an male 65-years-old with herniation bowel trought triangular ligament without surgical history abdominal.
DISCUSSION: The falciform ligament separates the left lateral and left medial segments along the umbilical fissure and anchors the liver to the anterior abdominal wall. The non-peritonealization of this ligament, which may be better understood as the failure of the two layers of peritoneum to fuse around the umbilical vein and to the abdominal wall leads to a defect between the round ligament and the anterior wall, configurating an abnormal opening through which any viscous could potentially herniate.
We present a very unusual cases of right upper abdominal pain due to the presence of an internal hernia through the falciform and triangular ligament in a patients without surgical history and otherwise healthy. Upon arrival, clinical findings did not suggest small bowel obstruction in the absence of nausea, vomiting or abdominal distention. Instead, biliary origin of symptoms was suspected. Ultrasonography only showed severely distended bowel loops and free liquid in right subphrenic space. It was abdominal CT scan findings and the persistence of symptoms what made us take the patients to the operating room.
Laparoscopic transection of the Falciform and triangular Ligament successfully released the entrapped loop with successful reperfusion by the end of the surgery. In the absence of any prothrombotic comorbidity, the patients were discharged asymptomatic without further anticoagulation.
To date only few similar cases have been reported, and most of them described in neonates and pediatric patients. To our knowledge, this cases reporteds in the elderlys. In this patients laparoscopic approach was both diagnostic and therapeutic with the transection the ligament.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87819
Program Number: P164
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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