Lipoma of the falciform ligament of the liver as a rare cause of chronic epigastric pain: A case report and review of literature

Pathologic conditions of the falciform ligament of the liver are rare. Only a few cases have been reported. We are reporting a case of chronic epigastric pain due to lipoma of the falciform ligament. Case report and discussion of the relevant literature is presented. A 38-year-old woman presented to the emergency room with a 5-day history of an exacerbated epigastric pain which has been on and off for 3 years. She was wrongly diagnosed to have peptic ulcer disease and has been on anti-ulcer regime for close to 6 months without improvement of symptoms. On physical examination, she was in painful distress, though generally preserved the tenderness in the epigastrium was accompanied by mild local rebound tenderness. Hence, it was difficult to properly delineate the abdominal mass in the epigastrium. Laboratory data done at this occasion and in the past were normal. Plain abdominal X-ray, contrast studies, and esophagogastroduodenoscopy findings were essentially normal. Only abdominal ultrasound revealed a suspected well-defined hypodense area located dorsally to the rectus muscles. Although the computed tomography and magnetic resonance imaging were not done due to logistics and financial constrain the patient presented with haven moved from one clinic to another receiving anti-ulcer regimen. A diagnosis of intra-abdominal mass was made, and the patient subsequently had an exploratory laparotomy. The findings at open operation through an upper midline abdominal incision were a moderate size lipoma of the ligament of the liver which was removed. Postoperative period and recovery was uneventful. Histology revealed well-differentiated adipocytes arranged in the nest with essentially benign features. The patient was discharged home and has remained hailed and hearty for 6 months of surgery. Tension due to lipoma of the falciform ligament of the liver is a rare cause of intractable epigastric pain associated with a diagnostic dilemma.