Surgical management of right hepatectomy after coronary artery bypass grafting using the right gastroepiploic artery: a case report and literature review.

BACKGROUND: Coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) is a well-established, safe procedure. However, problems with RGEA grafts in subsequent abdominal surgeries can lead to fatal complications. This report presents the first case of right hepatectomy for hepatocellular carcinoma after CABG using the RGEA. CASE PRESENTATION: We describe a case in which a right hepatectomy for an 81-year-old male patient with hepatocellular carcinoma was safely performed after CABG using a RGEA graft. Preoperatively, three-dimensional computed tomography (3D- CT) images were constructed to confirm the run of the RGEA graft. The operation was conducted with the standby of a cardiovascular surgeon if there was a problem with the RGEA graft. The RGEA graft had formed adhesions with the hepatic falciform ligament, necessitating meticulous dissection. After the right hepatectomy, the left hepatic lobe descended into the vacated space, exerting traction on the RGEA. However, this traction was mitigated by suturing the hepatic falciform ligament to the abdominal wall, ensuring stability of the RGEA. There were no intraoperative or postoperative complications. CONCLUSION: It is crucial to confirm the functionality and anatomy of the RGEA graft preoperatively, handle it gently intraoperatively, and collaborate with cardiovascular surgeons.

Hepatic falciform ligament appendagitis evaluated by ultrasound: A report of 2 cases.

Falciform ligament appendagitis is an extremely rare disorder, which is characterized by hematogenous or nonhematogenous inflammatory changes in the fat appendage that is contiguous with the falciform ligament. The imaging and clinical features of this condition are similar to those of epiploic appendagitis, especially when caused by torsion of the fatty appendage (ie, falciform ligament appendage torsion). We report 2 cases of falciform ligament appendagitis with localized epigastric pain. The ultrasound imaging features of the 2 cases presented here were an oval hyperechoic mass contiguous with the falciform ligament and increased echogenicity of the surrounding inflammatory fat. Both patients were managed conservatively with symptomatic treatment alone. Understanding the imaging features of this falciform ligament appendagitis is important, because ultrasound is often the first choice for noninvasive imaging of acute abdomen. As there is limited detailed literature on falciform ligament appendagitis comparing high-frequency linear probes with CT and MRI, we consider this case report to add valuable information on this poorly reported condition.

Internal hernia through hepatic falciform ligament iatrogenic defect in a neonate: A case report and review of the literature.

Internal hernia through an iatrogenic defect in the hepatic falciform ligament and acquired jejunal atresia in a 8-day-old neonate was reported. The PubMed, MEDLINE, CNKI, Wanfang and Weipu databases were searched The literature about the hepatic falciform ligament iatrogenic defect causing internal hernia was analysed. Ten other cases were collected from the world literature. Herniated intestinal necrosis was found in four cases. All cases were recovered uneventfully after operation. Internal herniation through an iatrogenic defect in the hepatic falciform ligament is extremely rare. However, the case reports are increasing, especially in the era of laparoscopic surgery. Adequate closure or open the defect is essential to prevent internal hernia occurrence.

Significance of the Hepatic Falciform Artery.

The authors present a case that highlights the anatomy of the hepatic falciform artery and describes its importance. The hepatic falciform artery is an anatomic variant that arises from the hepatic vasculature and provides arterial communication between the abdominal wall and the liver. It is essential to identify its presence, especially when surgery or embolization is planned for that area.