Kuribara Tadao, Shigeyoshi Itaru, Ichikawa Tatsuo, Osa Kiyoshi, Inoue Takeshi, Ono Satoshi, Asanuma Kozo, Kaneko Shiori, Sano Takayuki, Matsubara Kouta, Irie Naoko, Suzuki Kanako, Iai Akira, Ishizu Hideki
Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan.
Department of Pathology, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, Japan.
Surg Case Rep. 2022 Jun 14;8(1):112. doi: 10.1186/s40792-022-01466-x.
Falciform ligament abscess (FLA) is a rare disease, and its diagnosis can be challenging without typical image findings of an abscess. We report a patient with FLA that presented as a mass, with an indistinct border between it and the liver, in addition to disseminated foci within the liver. This made it difficult to determine whether it was FLA or a malignancy.
A 69-year-old man presented with epigastric pain. Contrast-enhanced computed tomography revealed a 25-mm mass below the middle of the diaphragm. Based on an initial diagnosis of infection of the falciform ligament, we administered conservative antibiotic treatment and there was initial improvement in the patient's clinical condition and laboratory data. However, he continued to experience mild epigastric pain. A month later, imaging studies revealed enlargement of the falciform ligament mass and the emergence of a new nodule in the liver, whereas laboratory findings showed re-elevated C-reactive protein levels. Since conservative treatment had failed, we decided to perform surgery. Considering the imaging study findings, malignant disease could not be ruled out. Based on the operative findings, we performed combined resection of the falciform ligament, left liver, and gallbladder. Histopathological examination of the resected specimens revealed extensive neutrophil infiltration and the presence of giant cells and foam cells within the lesions. These findings were indicative of abscess. Pseudomonas aeruginosa was cultured from the pus in the falciform ligament mass and bile in the gallbladder. Although multiple abscesses postoperatively developed in the residual portion of the liver, they could be treated through antibiotic therapy.
FLA can spread to both adjacent and distant organs via its rich vascular and lymphatic networks. When FLA displays atypical image findings and/or an atypical clinical course, it can be difficult to distinguish it from malignant disease. In such cases, surgical treatment, with intraoperative pathological diagnosis, should be attempted.
镰状韧带脓肿（FLA）是一种罕见疾病，若无典型的脓肿影像学表现，其诊断颇具挑战性。我们报告一例表现为肿块的FLA患者，该肿块与肝脏边界不清，且肝脏内有散在病灶，这使得难以确定其是FLA还是恶性肿瘤。
一名69岁男性因上腹部疼痛就诊。增强计算机断层扫描显示膈肌中部下方有一个25毫米的肿块。基于镰状韧带感染的初步诊断，我们给予了保守的抗生素治疗，患者的临床状况和实验室数据最初有所改善。然而，他仍持续感到轻度上腹部疼痛。一个月后，影像学检查显示镰状韧带肿块增大，肝脏出现一个新结节，而实验室检查结果显示C反应蛋白水平再次升高。由于保守治疗失败，我们决定进行手术。考虑到影像学检查结果，不能排除恶性疾病。根据手术所见，我们进行了镰状韧带、左肝和胆囊的联合切除。切除标本的组织病理学检查显示病变内有广泛的中性粒细胞浸润，以及巨细胞和泡沫细胞。这些发现提示为脓肿。从镰状韧带肿块的脓液和胆囊胆汁中培养出铜绿假单胞菌。尽管术后肝脏残余部分出现了多个脓肿，但可通过抗生素治疗。
FLA可通过其丰富的血管和淋巴网络扩散至邻近和远处器官。当FLA表现出非典型的影像学表现和/或非典型的临床病程时，可能难以与恶性疾病区分。在这种情况下，应尝试进行手术治疗，并进行术中病理诊断。
