Idiopathic segmental infarction of ligamentum teres hepatis. Variation on a theme...

Introduction: Idiopathic segmental infarction of the peritonealized intra-a bdominal fatty tissue is a rare cause of acute abdominal distress. Patients are operated for by suspected acute appendicitis or cholecystitis, and the true diagnosis is made intraoperatively. Methods: A 32-year-old woman was admitted to our hospital with a 2-day history of pain in the right upper ab domen. Clinical presentation suggested acute cholecystitis, but laboratory evaluation and sonography revealed no pathological findings. Because of a d istinctly palpable and very painful epigastric tumor 2 x 3 x 3 cm, a CT sca n was performed, that showed a clearly circumscribed mass in the ligamentum teres hepatis with hyperattenuating, infiltrating streaks. Laparoscopy was performed, and a tumor was found, that was adherent to the stomach's antru m and could easily be resected. Twenty-four hours after surgery the patient only felt slight discomfort and could be dismissed on the second day. Path ology report revealed a hemorrhagic infarction of the fatty tissue, which c an be histologically found in idiopathic segmental necrosis of the greater omenum or the appendices epiploicae. Conclusions: Laparoscopy is an excelle nt diagnostic tool and also has therapeutic possibilities. Resection of the necrotic tissue ensures faster recovery and pain control and should be per formed to prevent complications such as bacterial superinfection with forma tion of an abscess or spontaneous bleeding.