Between June 2017 and January 2018, a total of eleven consecutive patients underwent pancreatic resections with venous reconstruction by the falciform ligament
for extended pancreatic tumor disease at our institution; among them five patients underwent pylorus-preserving pancreaticoduodenectomy (PPPD), two patients received a pylorus preservation total pancreatectomy, two patients received a distal pancreatectomy with splenectomy, and two patients required an Appleby procedure in order to achieve radical tumor removal.
The peculiarity of this case presentation is based on the fact there has been acute thrombosis of the falciform ligament
in a noncirrhotic liver with a patent portal venous system.
The torsionalised falciform ligament
was removed laparoscopically.
 The average distance of these furrows from right layer of falciform ligament
was 7.35 cm in the present study, but no comparable data is available for this in the literature reviewed.
Other possible abdominal sites for the tumor include the liver, [sup] spleen, [sup] kidney, [sup] ligamentum hepatoduodenale, [sup] gall bladder, [sup] the falciform ligament
, [sup] and the omentum.
Initial findings were of dilated small bowel overlying the liver, and a diaphragmatic hernial defect visualised to the right of the falciform ligament
. Omentum and small bowel was noted entering the defect.
The falciform ligament
was separated from the anterior abdominal wall with a Ligasure to allow better visualisation of the hernia.
We prefer supraumbilical site for the primary port, though it has a slight theoretical disadvantage than the infraumbilical region due to presence of falciform ligament
. But, in our experience it has never been an issue whatsoever.
Traditionally this is associated with acute haemorrhagic pancreatitis as blood tracks via the falciform ligament
. Periumbilical ecchymosis may also occur in a myriad of conditions where haemoperitoneum is present as blood tracks from the fascia towards the tissues surrounding the umbilicus.
A whole falciform ligament
, extending as far as the navel, was found in all animals.
Lower end of the oesophagus and cardia through the gastro-oesophageal veins, the anal canal via the hemorrhoidal veins, in the falciform ligament
via the umbilical veins, in the abdominal wall and retroperitoneum.
(28) It commonly arises within the abdomen of young patients with predilection for the falciform ligament
and ligamentum teres of the liver; it is characterized by fascicular and nested proliferation of uniform spindle cells and less prominent nucleoli and lacks multinucleation.