title: [Internal herniation through the falciform ligament revealed by acute intestinal obstruction].
abstract: BACKGROUND
  Internal hernias are a rare cause of acute intestinal obstruction. Herniation through the falciform ligament is rare and often diagnosed only during surgery. Abdominal computed tomography (CT), performed on an emergency basis, can help to diagnose this obstruction before surgery and select a therapeutic approach.
  
  
  METHODS
  A 60-year-old man was hospitalized on an emergency basis for symptoms that had been developing for 3 days, including tympanites and epigastric pain (torsion), associated with vomiting and the cessation of both feces and flatus. Abdominal radiography showed multiple levels of air-fluid levels in the small bowel, some projecting towards the liver area, as well as the presence of a flat intestinal loop continuous with a distended small-bowel segment. Abdominal CT suggested a diagnosis of small-bowel herniation and obstruction, very probably through the falciform ligament. The patient then underwent emergency surgery after a brief resuscitation. Intraoperative exploration confirmed the diagnosis of internal hernia through the falciform ligament. The postoperative course was without problems.
  
  
  CONCLUSIONS
  Abdominal CT is the examination of choice in cases of a "new" acute intestinal obstruction. It makes it possible to diagnose the mechanism of the occlusion and especially the cause, especially for an internal hernia through the falciform ligament. It thus guides the choice of emergency surgical procedure and of appropriate approach. Once diagnosed, emergency surgery is essential to free the intestinal loop, with or without intestinal resection as a function of vitality.
authors.affiliation: Service de chirurgie générale A, Hôpital La Rabta, Tunis, Tunisie. h_bdioui@yahoo.fr
authors.forename: Heykal
authors.initials: H
authors.lastname: Bedioui
authors.forename: Amine
authors.initials: A
authors.lastname: Daghfous
authors.forename: Amine
authors.initials: A
authors.lastname: Daghfous
authors.forename: Rachid
authors.initials: R
authors.lastname: Ksantini
authors.forename: Kais
authors.initials: K
authors.lastname: Nouira
authors.forename: Faouzi
authors.initials: F
authors.lastname: Chebbi
authors.forename: Fadhel
authors.initials: F
authors.lastname: Fteriche
authors.forename: Wael
authors.initials: W
authors.lastname: Rebai
authors.forename: Mohamed
authors.initials: M
authors.lastname: Jouini
authors.forename: Montasser
authors.initials: M
authors.lastname: Kacem
authors.forename: Emna
authors.initials: E
authors.lastname: Menif
authors.forename: Zoubeir
authors.initials: Z
authors.lastname: Bensafta
mesh_terms: D000208:Acute Disease; D046449:Hernia, Abdominal / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011859:Radiography