A rare etiology of acute abdomen: a falciform ligament necrosis case report.

Background: Falciform ligament necrosis (FLN) is a rare and challenging condition often presenting with nonspecific symptoms resembling more common abdominal pathologies. Case Description: Here, we present a case of a 61-year-old male, admitted to emergencies with severe abdominal pain and one episode of vomiting. The patient initially diagnosed with mild acute pancreatitis and probable cholecystitis. Because of its severe clinical picture, the patient was admitted to our intensive car unit. Subsequent imaging revealed progression to gangrenous cholecystitis. Decision was taken to drain the gallbladder under computed tomography (CT) scan. Despite antibiotic therapy, the patient developed acute respiratory distress syndrome (ARDS), necessitating intubation. Upon stabilization, an exploratory laparoscopy revealed infected necrosis of the falciform ligament, prompting resection and drainage. Postoperatively, the patient presented a progressive clinical and biological amelioration. The drain was removed and the follow-up was uneventful. A laparoscopic cholecystectomy was scheduled 3 months later. Conclusions: FLN poses diagnostic challenges due to its nonspecific symptoms and tendency to mimic other abdominal pathologies. Diagnostic laparoscopy emerges as a valuable tool for both confirmation and treatment, enabling necrotic tissue excision and effective drainage. This case underscores the importance of considering rare entities like FLN in the differential diagnosis of abdominal acute pain, with laparoscopic intervention offering a definitive therapeutic option.