2020, Number 4
Unusual case: abdominal pain syndrome secondary to congenital defect of the round ligament of the liver in an adult patient
Garibaldi BM, Vega GFJ, Alvarado BR, Ruíz GGH
Full text
10.35366/101222
Language: Spanish
References: 10
Page: 213-216
PDF size: 178.22 Kb.
ABSTRACT
Introduction: All structural entrapments caused by the round liver/sickle ligament are produced by an abnormal fixation process of the anterior peritoneum in its embryonic stage. Such defects are rare, have a variety of clinical presentations, and are generally determined intraoperatively. The most common clinical manifestation associated with these defects is intestinal obstruction. Tomography of the abdomen is performed routinely in the emergency department, it can help get a preoperative diagnosis and guide the therapeutic attitude to be carried out, but there are no characteristic tomographic data of this pathology. In cases where there is no specific or conclusive judgement, a diagnostic laparoscopy is indicated to identify any causal etiology under direct vision. There are few cases published in the literature; these were found at a late stage and mostly in adults. Case presentation: This is the case of a female 45-year-old patient who came to the emergency department with acute abdominal pain. Said patient had never had an abdominal surgery. A physical examination was irrelevant and did not match the patient's symptoms. Extension studies were carried out, where an abnormal arrangement of jejunal loops was evidenced by tomography, posterior to the stomach, and displacement of the descending colon towards the medial, without evidence of ischemia or perforation. A diagnostic laparoscopy was performed, where the transverse colon and small intestine (jejunum) were identified through a hole at the junction of the falciform and the round ligaments of her liver, which was resolved with a blunt technical cut of the posterior border of such ligaments and subsequent release of intestinal loops, which presented spontaneous peristalsis. Today, diagnostic laparoscopy is widely used as an identification and treatment for inconclusive clinical pictures and uncertain diagnoses. In the case presented, it was found that the transverse colon and the small intestine (duodenum) crossed a hole in the round/falciform ligament of the liver, which was resolved with a blunt technical cut of the posterior border of the ligament and subsequent release of the intestinal loops, which presented spontaneous peristalsis. Intestinal resection with subsequent anastomosis was not necessary. Conclusion: An accurate diagnosis is only possible under direct vision in surgery, where, in addition to being diagnostic, it is therapeutic. The authors propose the term "inclusion in the round ligament of the liver/sickle cell" as a concept to encompass these clinical presentations of pain, occlusion, or other digestive pathology, which are accompanied by an abnormal fixation of the structures of the digestive system towards the sickle/round ligament of the liver.REFERENCES