A Case of Successful Laparoscopic Surgery to Control Bleeding in the Round Ligament of the Liver Caused by Upper Abdominal Stab Wounds

Abstract

A 37-year-old woman presented to the emergency room with an upper abdominal stab wound. She had stabbed herself at home with a 25-cm long kitchen knife after a domestic dispute. The knife had been removed at the scene, and her respiratory and circulatory statuses were stable when she came to the hospital. Abdominal computed tomography revealed a hematoma in the round ligament of the liver and a hollow abdominal viscus under the piercing path. We performed diagnostic laparoscopy. Although no apparent organ damage was observed, the round ligament of the liver was swollen due to hematoma formation. After incision of the round ligament of the liver along the peritoneum, venous bleeding was observed from the abdominal wall, which was stopped laparoscopically. In the past, laparotomy was considered as being indicated in all cases of round ligament hematoma; however, conservative treatment is also now an option, and indications for surgery are controversial. In summary, even if a small hematoma is suspected on preoperative imaging, laparoscopy should be used for investigation, and hemostasis should be performed.