Falciform Ligament Inflammation Complicated by Umbilical Vein Thrombophlebitis, Left Portal Vein Thrombosis, and Multiple Hepatic Abscesses: A Case Report

Falciform ligament pathology is a rare cause of acute upper abdominal pain and may resemble more common pancreatic and hepatobiliary disorders.A woman in her 50s presented with sudden severe epigastric pain radiating to her back and marked hyperamylasaemia of 1,747 U/L.This combination fulfilled clinical and biochemical diagnostic criteria for acute pancreatitis, although computed tomography (CT) demonstrated no pancreatic inflammation and instead showed severe inflammatory change centred on the falciform ligament, with associated focal fat infarction, left portal vein thrombosis, and gas locules within segment IV of the liver.The patient subsequently developed fever, tachycardia, lactic acidosis, and profound hypotension requiring intensive care admission, intravenous antimicrobial treatment, fluid resuscitation, and vasopressor support.Serial CT and magnetic resonance imaging (MRI) demonstrated progressive falciform ligament inflammation, thrombophlebitis of the recanalised umbilical vein, occlusive left portal vein thrombosis, and multiple left-lobe hepatic abscesses.Blood cultures obtained during the febrile deterioration subsequently showed no growth.She improved with prolonged broad-spectrum antimicrobial therapy and therapeutic anticoagulation.Percutaneous drainage was deferred because she remained clinically stable, her inflammatory markers improved, and the hepatic abscesses remained small and stable on serial imaging.Follow-up CT demonstrated resolution of the hepatic abscesses, reduction in the falciform ligament collection, and recanalisation of the umbilical vein, although the left portal vein thrombosis persisted.Transabdominal ultrasonography during the index admission demonstrated small gallstones.She was subsequently readmitted with recurrent upper abdominal pain, marked hyperamylasaemia, and CT evidence of acute cholecystitis, with the overall clinical picture considered consistent with gallstone pancreatitis.An outpatient CT four weeks after the second discharge demonstrated resolution of the gallbladder inflammatory changes, while the falciform ligament thickening and fluid density remained stable.This case demonstrates a rare and potentially life-threatening falciform ligament inflammatory process associated with portovenous thrombosis and hepatic abscess formation in the context of sepsis.The index presentation also met accepted diagnostic criteria for acute pancreatitis, and a concomitant biliary contribution could not be excluded.The case highlights the value of serial cross-sectional imaging, multidisciplinary management, and cautious interpretation of overlapping pancreatic, biliary, and falciform ligament pathology.