Falciform ligament hernia

Falciform ligament hernias (alternative plural: herniae) are a very rare type of internal hernia occurring through a defect in the falciform ligament.

Epidemiology

Exceedingly rare, thought to comprise just 0.2% of all internal hernias ⁴.

Associations

• laparoscopic surgery ²

Clinical presentation

The commonest presentation is that of a small bowel obstruction.

Pathology

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.

Radiographic features

CT

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 . 

See also

• internal hernia