Falciform ligament aperture causing intestinal strangulation

In rare cases intestinal obstruction may be caused by herniation of small bowel through a defect in the falciform ligament. Such a case was that of a 28-year-old woman who had a 26-week twin pregnancy. She had acute upper abdominal pain. The diagnosis was acute appendicitis, but at operation a loop of ileum was found to have passed through an aperture in the falciform ligament. The loop was gangrenous and required resection. Her course was complicated by delivery of two infants on the day after operation; one died within a few hours and the other 4 months later. The patient recovered after a second operation 2 weeks later for small bowel obstruction due to adhesions. Only six other patients with this anomaly have been reported. Two were neonates. Three patients died. This complication of pregnancy has not been described before. Dislocation of the small intestine by the enlarged uterus may have contributed to the herniation. Prompt operation is mandatory in this condition as in any case of closed-loop bowel obstruction.