Work

A diagnostic dilemma: a rare case of falciform ligament abscess from gallbladder perforation masquerading as pancreatitis and subsequent abdominal wall cellulitis

Year: 2026

Type: article

Abstract: Introduction and importance: Pathology of the falciform ligament is rare in adulthood due to the closure of the communication of the umbilicus with the external environment during embryological development. Compared to the pediatric population, where pathologies arise from external communication, falciform ligament abscesses in adults occur as a sequelae of hepatopancreaticobiliary pathology through an unclear mechanism. Falciform ligament abscess in adults is an exceedingly rare complication, with only 19 cases published in English literature. Case presentation: A 77-year-old male presented with right upper quadrant and epigastric pain and fevers in the setting of deranged liver function tests, elevated lipase, and no radiological evidence of cholecystitis, pancreatitis, or liver pathology. Gallbladder perforation, communication, and falciform ligament abscess formation were confirmed on interval computerized tomography during admission. They were initially managed with antibiotics, cholecystectomy, and intraoperative drainage of the abscess. Re-accumulation of the abscess required further antimicrobial therapy and wound drainage. They made a full recovery without complications. Clinical discussion: We present 1 of 2 published cases of gallbladder perforation into the falciform ligament with subsequent abscess formation. Our case demonstrates a pathologic communication between gallbladder and falciform ligament, contrary to the current hypothesis of abscess formation. Moreover, there was absence of a demonstratable cause of portal venous reflux as a mode of bacterial transit. Conclusion: Definitive management of the causative pathology and drainage of a non-loculated abscess is reasonable, and prompt diagnosis and management are required to prevent further complications, such as sepsis or cholecysto-umbilical fistula formation.

Source: International Journal of Surgery Case Reports

DOI: 10.1097/rc9.0000000000000081

Authors: Jayden A. Wearne, Hannah Truong, Michael Rouse, Matthew Shears

Institution: The Royal Melbourne Hospital

Language: English

Topic: Gallbladder and Bile Duct Disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090