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Case Reports
. 2023 Mar 25;18(5):2039-2042.
doi: 10.1016/j.radcr.2023.02.058. eCollection 2023 May.

Falciform ligament hernia: combination of key CT findings

Tomonori Matsuura  1 , Nozomi Satani  1 , Ryo Tamura  1 , Yuriko Kagaya  1 , Takayuki Yamada  1
Affiliations
Case Reports

Falciform ligament hernia: combination of key CT findings

Tomonori Matsuura et al. Radiol Case Rep. .

Abstract

A male patient in his early 90s with no history of abdominal surgery was referred to us for abdominal pain and vomiting. An abdominal computed tomography (CT) demonstrated dilated small bowel with a double beak sign and poorly enhanced wall, which indicated a closed-loop obstruction that leads to strangulation. A closed-loop bowel was located in front of the anterior and medial segments of the liver and to the right of the round ligament of the liver on axial images. Sagittal images revealed that the round ligament has deviated downward and 2 adjacent narrowed intestines were located at its cranial side. These CT findings suggested the hernia orifice was in the falciform ligament. Emergency surgery for highly suspected bowel ischemia revealed the falciform ligament hernia. A combination of the CT findings played a key role, including the double beak sign, the location of the closed-loop small bowel, and the downward deviation of the round ligament, although preoperative CT diagnosis of falciform ligament hernia is a diagnostic challenge.

Keywords: Double beak sign; Falciform ligament hernia; Internal hernia; Round ligament of the liver.

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Figures

Fig 1
Fig. 1
Contrast-enhanced CT. Cranial (A) to caudal (D) axial CT images show a double beak sign (arrowhead) in front of the medial segment of the liver; the closed-loop small bowel (asterisk) is seen in the right side of the round ligament (arrow).
Fig 2
Fig. 2
Sagittal CT image 2 months before admission (A) and drawing of nonpathologic status (B) shows normal anatomy of falciform ligament and round ligament (arrow). Sagittal CT image after admission (C) and drawing of the falciform ligament hernia (D) shows herniated small bowel (asterisk) through defect in falciform ligament and 2 narrowed intestines (arrowhead) above the round ligament (arrow). The round ligament of the liver is deviated inferiorly relative to normal status and the distance between round ligament and liver becomes larger.
Fig 3
Fig. 3
The hernia orifice was operatively observed in the falciform ligament (star). The direction of herniation was left to right.
See this image and copyright information in PMC

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