A Case of Falciform Ligament Hernia that was Possible to Avoid Intestinal Resection by ICG Fluorescence Image

Abstract

We encountered a case of incarcerated falciform ligament hernia that originated from an abnormal falciform ligament. In our hospital, we use a technique known as “indocianine green (ICG) fluorescence imaging,” which can evaluate blood flow on an endoscopic image, thereby providing an opportunity to avoid intestinal resection.

The patient was a 53-year-old woman who presented at the emergency department with worsening upper abdominal pain lasting several hours. On clinical examination, a diagnosis of incarcerated falciform ligament hernia was made and emergency laparoscopic surgery was performed. The incarcerated small intestine was manually dissected to disentangle it. Adequate blood flow in the entire incarcerated small intestine was ensured by ICG fluorescence imaging through detection of infrared emission. Necrosis was, thus, ruled out, and the small intestine was preserved. The patient had no complications and was discharged from the hospital on the sixth day after surgery.

ICG fluorescence imaging can evaluate blood flow on an endoscopic image, and it is, therefore, considered to be a useful method that obviates the need to tow the incarcerated intestinal tract out of the abdominal cavity through a small incision on the abdominal wall.