Transcript Omental infarction of the round ligament of live

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, noncompressible 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
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