Internal hernias through the falciform ligament: a case series and comprehensive literature review of an increasingly common pathology

Abstract

Purpose: Internal hernias remain difficult to diagnose, despite advances in preoperative imaging. The anatomy of internal hernias varies widely, but herniation through the falciform ligament remains a rare entity. Sparse case reports are present, and no review has adequately synthesized all available information within the literature. Two patients presented to our institution with internal hernias through the falciform ligament over the span of 3 months.

Methods: A PubMed search was performed for any article containing both the terms "falciform" and "hernia." These articles and their references were examined, identifying 35 cases in the world literature, in addition to the two at our institution. Reports were examined for demographics, mode of diagnosis, hernia etiology, hernia contents, need for resection, and survival.

Results: Five cases of falciform hernia were correctly diagnosed by preoperative imaging. Bowel resection was necessary in 43 % of patients, and mortality was 12 %. Incidence of falciform hernias is increasing.

Conclusion: This pathology is a rare, though increasingly frequent, phenomenon that must be considered in the differential diagnosis when a bowel obstruction without other identifiable cause is encountered, particularly in a patient with history of previous laparoscopy. However, preoperative studies have a poor sensitivity for accurately diagnosing a hernia through the falciform ligament. Failure to consider this etiology may result in delayed operative intervention and increased morbidity and mortality.