Torsion of the Falciform Ligament Fatty Appendage: An Overlooked Cause of Abdominal Pain in Adults

BACKGROUND Torsion of the falciform ligament fatty appendage is a rare subset of intra-abdominal fat infarction. Fewer than 20 cases have been reported in the literature to date. Clinical and laboratory findings are non-specific, making imaging essential for diagnosis and management. CT typically shows a fat-density lesion with surrounding inflammatory changes along the falciform ligament, which is diagnostic. Recognizing this rare entity can prevent unnecessary surgical exploration. CASE REPORT We present 2 cases: a 47-year-old Chinese woman and 32-year-old Chinese man with right upper-abdominal and epigastric pain, respectively. Associated symptoms such as nausea, non-bilious vomiting and anorexia were reported. On clinical examination, tenderness was elicited upon palpation without guarding. Laboratory tests were unrevealing, with normal liver function and lipase markers. In view of persistent abdominal pain in both cases, a CT abdomen and pelvis was performed, which showed inflammatory changes along the course of the falciform ligament, suggestive of torsion of the falciform ligament fatty appendage. Both patients were subsequently managed conservatively and discharged in good condition several days later. CONCLUSIONS Torsion of the falciform ligament fatty appendage is a rare but important cause of right upper-abdominal or epigastric pain. By discussing the clinical presentation, imaging findings, and treatment options of this condition, we aim to raise awareness of this pathology as a potential differential diagnosis for such pain.