Exceedingly rare, thought to comprise just 0.2% of all internal hernias 4.
- laparoscopic surgery 2
The commonest presentation is that of a small bowel obstruction.
Requires the presence of an abnormally patent orifice in the falciform ligament, requiring both layers of the peritoneal folds which compose the ligament. The etiology of the defect may be congenital, traumatic, or iatrogenic; the latter is primarily due to injury accrued during laparoscopic surgery, hence the epidemiologic association 2. Most herniations involve the small bowel, but herniations of omentum and the colon have been described.
A falciform ligament hernia should be considered when a fluid-filled, curvilinear, dilated bowel loop is identified just anterior/inferior to the liver 1. The round ligament marks the inferior-most extent of the falciform ligament, and may be used as a landmark. The accompanying obliterated falciform artery and paraumbilical veins travel along this course as well, but are seldom visible.
The hernia has not been observed to result in the sac-like clustering of bowel loops characteristic of e.g. paraduodenal internal hernias .
- 1. Doishita S, Takeshita T, Uchima Y, Kawasaki M, Shimono T, Yamashita A, Sugimoto M, Ninoi T, Shima H, Miki Y. Internal Hernias in the Era of Multidetector CT: Correlation of Imaging and Surgical Findings. Radiographics. 2016 Jan-Feb;36(1):88-106. doi: 10.1148/rg.2016150113. Epub 2015 Nov 20. PMID: 26587890.
- 2. Charles A, Charles SA, Charles DS, Charles KE, Charles. Falciform ligament hernia after laparoscopic cholecystectomy: a rare case and review of the literature. (2005) The American surgeon. doi: - Pubmed
- 3. Egle, J., Gupta, A., Mittal, V. et al. Internal hernias through the falciform ligament: a case series and comprehensive literature review of an increasingly common pathology. Hernia 17, 95–100 (2013). https://doi.org/10.1007/s10029-012-0990-6
- 4. Internal herniation through a defect in the falciform ligament: a case report and review of the world literature. (2000) Hernia. 4 (2): 117. doi:10.1007/BF02353760
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