Falciform ligament and gastrohepatic ligament appendagitis, a rare cause of abdominal pain

Introduction

The term intraperitoneal focal fat infarction (IFFI) is used to describe intraperitoneal focal fat tissue necrosis. The most common examples are epiploic appendagitis and omental infarction. Additionally, the less common perigastric appendagitis refers to focal fat necrosis developing secondary to the torsion of the perigastric ligaments [1]. Around the stomach are connective tissue elements rich in fatty tissue, such as the gastrohepatic ligament, gastrosplenic ligament, gastrocolic ligament, and falciform ligament. Ischemia (due to torsion) and inflammation of these ligaments can cause a rare acute abdominal disorder, commonly referred to as perigastric appendagitis [2]. Findings related to torsion may be observed in the perigastric ligaments on CT scans, and induration may be seen in the ligaments secondary to infection and inflammation of surrounding organs. Therefore, it is crucial to rule out ligament induration resulting from other causes [3].

Perigastric appendagitis usually presents with localized abdominal pain. Fever is not usually present. Laboratory tests may show an increase in inflammatory parameters such as leukocytosis and elevated C-reactive protein (CRP). Diagnosis is made by ultrasound and especially CT. Ultrasound imaging reveals a non-compressible oval hyperechoic area at the site of pain. The CT findings are characterized by focal density and volume increase in the area where ischemia developed as a result of torsion. The linear hyperdense image sometimes seen at the center of the falciform ligament, known as the “central dot sign”, indicates a thrombosed vascular structure [4]. The condition is usually treated with conservative approaches such as hydration and pain relief (NSAIDs, opioids). Surgery may also be performed for persistent pain in falciform ligament torsion [5].

Publication History

Received: 08 November 2025

Accepted after revision: 12 December 2025

Article published online:
07 January 2026

• References

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