[Internal abdominal hernia caused by anomaly of the falciform ligament (a case report)]

The authors describe a truly uncommon case of internal abdominal hernia attributable to malformation of the falciform ligament. The patient, a man aged 26, had complained in the past of cramping pain in the epigastric region, usually occurring after meals and sometimes ending with vomiting of ingested food; but all diagnostic methods and procedures had consistently ruled out any extant pathology of the stomach, duodenum, biliary tract, or pancreas. Present hospitalization was justified by a clinical picture suggesting peritonitis from perforated gastric or duodenal ulcer. At operation the authors found a strangulated loop of small intestine following left-to-right migration through a hole in the falciform ligament of the liver. In the authors' interpretation the background cause of the trouble was incomplete development of the falciform ligament, and the immediate cause of the acute episode was abnormal motility and exaggerated peristalsis of the ileum, possibly due to the presence of a diverticulum; the latter two conditions are invoked as a possible explanation for the repeated episodes of abdominal pain in the patient's history.