Necrosis of the liver round ligament in a 12-year-old child

BACKGROUND: The round liver ligament (RLL) is a fibrous cord-like remnant of the umbilical vein that fixes the liver to the anterior abdominal wall. Complications such as RLL abscess and necrosis are extremely rare in children compared to adults. Only isolated observations are described in the literature.

The etiopathogenesis of RLH necrosis has not been fully studied. Discussion on etiopathogenesis of this disease is still under way. A number of authors state that the inflammatory process spreads along the umbilical vein in case of inflammatory diseases of the abdominal organs. Timely diagnostics of RLL necrosis is extremely difficult, not only in the preoperative period, but also during surgery. Only in isolated cases, the diagnosis is put before surgery. In most cases, children are operated on with diagnosis of acute appendicitis, cholecystitis, perforated gastric ulcer.

AIM: To draw the attention of practicing doctors to such a rare pathology as necrosis of the round ligament of the liver.

CLINICAL CASE DESCRIPTION: The authors describe a clinical case of managing a 12-year-old child who was admitted to the pediatric surgical clinic by the ambulance with clinical signs of acute abdomen and acute cholecystitis. The authors mark difficulties which they faced in diagnosing and treating the case both before and during surgery. Coccygeal cartilage necrosis was put only intraoperatively. The early postoperative period was uneventful. The patient was discharged on day 12 after the surgery in the satisfactory state.

CONCLUSION: This clinical observation is of undoubted interest to specialists as a rare pathology which is difficult for diagnosing both before and during surgery.