[Gangrene of the round liver ligament: an unrecognized pathology]

The necrosis of the ligamentum teres hepatis is a very rare and unrecognized pathology. Two cases only were reported in the literature. The presence of generalized or epigastric peritoneal signs, simulates acute cholecystitis or perforated pyloric ulcer. The diagnosis could be suggested by ultrasonography and CT scan of the abdomen revealing a hyperechogenic and hypodense focal lesion at the junction of the segments III and IV of the liver, associated with inflammatory signs and/or collection along the ligamentum teres. The etiology of this necrosis remains unclear, although in this case report, a ligament infection with E. Coli, Enterococcus and Klebsiella pneumoniae was observed. However, the primum movens of the infection is unknown. The proposed treatment is resection of the ligament from umbilicus up to the liver, associated with systemic antibiotherapy, because of the possible risk of propagation of the infection to the portal vein.