Pre-operative diagnosis and successful surgery of a strangulated internal hernia through a defect in the falciform ligament: a case report
1 Department of GI Surgery, St Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
2 Division of General Internal Medicine, Department of Medicine, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
3 University of Hawaii, Department of Internal Medicine, Honolulu, HI, USA
Journal of Medical Case Reports 2012, 6:206 doi:10.1186/1752-1947-6-206Published: 18 July 2012
Internal hernia within the falciform ligament is exceedingly rare. A literature search revealed only 14 cases of internal herniation of the small bowel through a congenital defect of the falciform ligament, most of which were found intra-operatively.
A 77-year-old Japanese woman presented to our emergency department with sudden hematemesis, occurring at least four to five times over a 12-hour period. No ulcer or gastrointestinal bleeding was detected on gastroendoscopy. A 40mm mass in the inferior lobe of the right lung was found on a chest X-ray, and our patient’s symptoms were therefore initially ascribed to aspirated blood from lung tumor-associated hemoptysis. However, our patient continued to show signs of severe abdominal pain and decreased urine output despite aggressive hydration, leading her examining physicians to search for a possibly severe, occult abdominal pathology. On emergent computed tomography imaging, we found an acute strangulated internal hernia within the falciform ligament. Diagnosis was made by helical computed tomography, permitting rapid surgical intervention.
Our findings on computed tomography imaging assisted with the pre-operative diagnosis and enabled us to make a rapid surgical intervention. Early diagnosis may help preclude significant strangulation with unnecessary resection.