Current concepts in falciform ligament hernia diagnosis and treatment. A systematic review

Falciform ligament hernia (FLH) is a highly uncommon type of internal hernia. This internal hernia presents diagnostic difficulties due to its ambiguous clinical symptoms, which can resemble other causes of acute abdominal pain.

A systematic literature review of cases of falciform ligament hernia was conducted on 5th December 2024 according to PRISMA guidelines and using PubMed and Google Scholar databases.

Among 103 articles, 36 were included in our review. In total 50 patients were reported. The median age at diagnosis was 41 years. Upper abdominal pain and vomiting were the predominant symptoms. Computed Tomography (CT) scan was instrumental in detecting this rare hernia. Despite this, a definitive diagnosis is often established in the surgical setting. The causes of FLH are diverse, including both congenital and acquired elements. Congenital factors (70%) may involve embryological defects or complete failure in the development of the falciform ligament. Acquired causes might stem mainly from previous abdominal procedures (28%) or injuries (2%). The small bowel was responsible for 78% of cases. Emergency laparotomy was performed in 70% of patients, while 28% were managed with laparoscopy.

The treatment for FLH is solely surgical. Laparoscopic methods are preferred, providing faster recovery, enhanced visualization for reducing the hernia, and assessing bowel viability. In cases of severe complications such as bowel ischemia and perforation, open surgery may be necessary. Prompt surgical intervention is crucial to achieve a positive outcome and reduce morbidity.