Peritonitis Secondary to Ligamentum Teres Hepatis Gangrene: A Case Report and Review of the Literature

Nolasco Vaz J1*, Sousa M1 , Peixoto A2 , Rebelo dos Santos V1 , Fernandes S1 , Ferreira J1 , Marques J1 and Coutinho J

Department of General Surgery, Centro Hospitalar Universit?rio Lisboa Norte, Portugal 2 Department of Radiology, Centro Hospitalar Universit?rio Lisboa Norte, Portugal

^*Correspondance to: Joana Nolasco Vaz 

 PDF  Full Text DOI: 10.25107/2474-1647.3081

Abstract

Ligamentum teres hepatis necrosis is a rare entity. Few surgeons are aware of its existence, and even fewer have clinically dealt with it. Its physiopathology is yet to be unraveled but might result from superinfection of an intra-abdominal focal fat infarction in the presence of biliopancreatic disorders. We herein present a case report of a 63 year-old woman with acute peritonitis and septic shock resulting from falciform ligament gangrene, with initial diagnostic hypothesis of acute pancreatitis or perforated duodenal ulcer. Antibiotic and surgical management with complete round ligament excision was performed even though not achieving the desired outcome. A review of the literature acknowledged 40 other case reports. Epidemiology and clinically relevant information was assembled. It has a female preponderance mainly presenting in the 7th decade of life. Although computed tomography scan images are characteristic in 75% of the cases, the diagnosis was made pre-operatively in only 40%. In 51% there was an associated hepatobiliary condition (cholangitis, choledocholithiasis, and acute cholecystitis). Conservative approach has a 50% failure rate and the treatment should consist in surgical resection of the ligament by open or laparoscopic approach, allowing exclusion of concomitant disorders. The mortality rate was 4.9%.

Keywords

Round ligament; Ligamentum teres hepatis; Falciform ligament; Abscess; Necrosis; Inflammation

Cite the article

Nolasco Vaz J, Sousa M, Peixoto A, Rebelo dos Santos V, Fernandes S, Ferreira J, et al. Peritonitis Secondary to Ligamentum Teres Hepatis Gangrene: A Case Report and Review of the Literature. Clin Surg. 2021; 6: 3081..