Utilisation of the falciform ligament pedicle flap as an alternative approach for the repair of a perforated gastric ulcer

• Published in: BMJ case reports Vol. 2016; p. bcr2015213025
• Main Authors: Boshnaq, Mohamed, Thakrar, Amit, Martini, Iana, Doughan, Samer
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 21.04.2016; BMJ Publishing Group
• Series: Case Report
• Subjects: 80 years; Abdomen; Aged, 80 and over; Digestive System Surgical Procedures; Female; Humans; Ligaments - surgery; Liver; Mortality; Novel Treatment (New Drug/Intervention; Established Drug/Procedure in New Situation); Omentum; Ostomy; Peptic Ulcer Perforation - surgery; Stomach Ulcer - surgery; Surgical Flaps; Ulcers; United Kingdom; White
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2015-213025

An 83-year-old woman presented to the emergency department with sudden onset of severe abdominal pain. She had a background of ulcerative colitis managed surgically at the age of 18 years with panproctocolectomy and permanent ileostomy. On admission, clinical assessment suggested a visceral perforation and an urgent CT scan demonstrated a perforated prepyloric ulcer. Emergency laparotomy was performed and confirmed a 3 cm perforated pre-pyloric ulcer. Repair of the defect was challenging due to the absence of omental fat to patch the perforation. A modification to the standard technique was therefore performed: the falciform ligament was mobilised and its free end used as a patch to repair the defect. The patient made a good postoperative recovery. This case report highlights an alternative operative technique for the treatment of perforated gastric/duodenal ulcers in patients who lack omentum, or when omentum cannot be used to cover perforated gastroduodenal ulcers.