OMENTAL INFARCTION OF THE ROUND LIGAMENT OF LIVE

S. Boutachali, M. Mahi, T. Amil, S. Chaouir - Rabat - Service d’imagerie médicale- HMI Mohammed V. CHU – Rabat

GI3

Introduction

The omental infarction of the round ligament of the liver is an exceptional

and little-known disease, fewer than 6 cases reported in the literature.

The clinical presentation, impressive, is suggestive of peritonitis. The pathophysiology of this isolated infarction is unknown.

CT is the choice modality for the most reliable exclusion of diseases whose clinical expression is close and justify surgical abstention.

We report the case of a patient presenting to an array of acute pain with abdominal defense in which the scan reveals a lesion of fat density in the crack of the round ligament, with an extension parietal subperitoneal.

Observation

A 50-year-old patient who presented to the emergency for a diffuse abdominal pain and vomiting all operating in a context of deterioration of general condition.

Biology shows a discrete inflammatory syndrome.

The patient was explored by abdominopelvic CT

Figure 1: CT scan after injection. a, b: well-circumscribed mass, fat, prehepatic, in the fissure of round ligament enhancing quietly after injection of the contrast.

Figure 1: CT scan after injection.

c, d: the mass has a subperitoneal parietal extension

Result

The abdominopelvic CT revealed a circumscribed mass of fat density, prehepatic, in the crack of the round ligament at the junction of segments III and IV of the liver (Figure 1a, b), with an subperitoneal parietal extension (Figure 1C, d), this mass is enhancing quietly after injection of the contrast. Gallbladder, pancreas and digestive adjacent structures are normal.

The diagnosis of omental infarction of the round ligament was retained. The development being resolved with simple analgesics

Discussion

The omental infarction of the round ligament of liver disease is very rare and unknown whose frequency is underestimated.

The clinical presentation is nonspecific with epigastric or generalized peritoneal signs, can be confused with acute cholecystitis or perforated pyloric ulcer.

The cause is unknown can be ischemic or infectious germs by digestive origin. Biology is generally nonspecific, normal or showing a discreet inflammatory Syndrome (3).

Discussion

In ultrasound, the picture is that of a moderately hyperechoic mass, solid, between the two edges of the liver, non-compressible and completely isolated with integrity of the digestive adjacent structures (1).

This sign can eliminate the hypothesis of a plastron in connection with cholecystitis, or diverticulitis (2.4).

Discussion

In CT, the mass was well circumscribed, fat, prehepatic, in the crack of the round ligament, streaked with concentric hyperdense linear features (fibrous bands and dilated thrombosed veins) and without disease of adjacent organs.

The presence of concentric linear bands at the mass is considered pathognomonic of omental torsion, but only two cases have been reported to date (3).

Discussion

The differential diagnosis of omental infarction of the round ligament of the liver arises with other ischemic lesions of the omentum: appendagitis or omental torsion of appendix, infarction of the omentum and lesser omentum, however, reaching the round ligament and Headquarters Pre liver mass orient the diagnosis (4).

The diagnostic challenge raised by the couple ultrasound and CT, however, is important since a well-posed diagnosis allows surgical abstention, the evolution is usually resolved with simple analgesics (5.6).

Conclusion

The omental infarction of the round ligament of the liver is a rare condition that presents characteristics CT findings for the diagnosis and thereby allowing the surgical abstention.

Références

S Novellas, L Mondot , T Caramella, M Senni, P Chevallier et JN Bruneton. Pathologie du ligament rond : à propos de deux cas.J Radiol 2008;89:510-3

Coulier B, Cloots V, Ramboux A. US and CT diagnosis of a twisted lipomatous appendage of the falciform ligament. Eur Radiol 2001; 11:213-5.

B. Coulier, J. Pringot. Pictorial essay infarction of the greater omentum:can us and ct findings help to avoid surgery?JBR–BTR, 2002, 85: 193-199

M Azaiez, M Zins, D Régent, MC Jullès, F Pilleul, G Genin, JM Bruel. Pathologie ischémique de l'épiploon : présentations atypiques. J Radiol 2006;87:1471

Lloyd.T. Primary torsion of the falciform ligament: computed tomography and ultrasound findings.Australasian Radiology 2006;50: 252-254

Coulier B, Cloots V, Ramboux A. US and CT diagnosis of a twisted lipomatous appendage of the falciform ligament. Eur Radiol 2001 ; 11 : 213-215