Losanoff Julian E, Kjossev Kirien T
Department of Surgery, University of Missouri-Columbia, USA.
Am Surg. 2002 Sep;68(9):751-5.
Isolated infection and/or gangrene of the round and falciform liver ligaments is among the rarest causes of acute abdomen. The diagnosis is based on demonstrating localized or patchy inflammatory or gangrenous changes in the ligaments without apparent etiology. We report the case of an 18-year-old male who presented with a 24-hour history of generalized abdominal pain and distention, nausea, and vomiting. With a preoperative diagnosis of probable perforated duodenal ulcus and generalized peritonitis the patient underwent emergency surgery. Multiple patchy gangrenous areas of the round and falciform ligaments were found starting from the umbilicus up to the hepatic hilum. The ligaments were resected in toto. The patient's postoperative course was unremarkable. No apparent etiology of the condition was found. We provide the first extensive review of the world literature. Isolated infection and/or gangrene of the round and falciform liver ligaments should be suspected in patients with upper abdominal complaints when imaging studies demonstrate ligament abnormality, tumor, or fluid. Treatment is only surgical. Depending on surgeon's expertise, patient's condition, and severity and extent of disease either open or laparoscopic surgery may be performed.
肝圆韧带和镰状韧带的孤立性感染和/或坏疽是急性腹痛最罕见的病因之一。诊断基于在韧带中发现局限性或片状炎症或坏疽性改变且无明显病因。我们报告一例18岁男性患者，有24小时的全腹疼痛、腹胀、恶心和呕吐病史。术前诊断为可能的十二指肠溃疡穿孔和弥漫性腹膜炎，患者接受了急诊手术。发现从脐部到肝门的肝圆韧带和镰状韧带多处有片状坏疽区域。韧带被全部切除。患者术后病程平稳。未发现该病症的明显病因。我们对世界文献进行了首次全面综述。当影像学检查显示韧带异常、肿瘤或积液时，有上腹部症状的患者应怀疑肝圆韧带和镰状韧带的孤立性感染和/或坏疽。治疗仅为手术治疗。根据外科医生的专业技能、患者状况以及疾病的严重程度和范围，可选择开腹手术或腹腔镜手术。
