Sri Harsha Bokka1, Bikram K Behera2, Manoj Kumar Mohanty3. 1. Department of Surgery, J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh, India. 2. Department of Anaesthesia, J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh, India. 3. Department of Paediatric Surgery, J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh, India.
Sir,Abscess formation of the falciform ligament in neonates is a known complication of omphalitis, and we encountered two such cases in neonates who were delivered at their homes by a birth attendant. Our patients, in neonatal age group presented with a swelling in epigastrium, deranged liver function tests, fever, and other constitutional features with a hypoechoic lesion in anterior abdominal wall on ultrasonography (USG). Computed tomography (CT) was suggestive of the condition [Figure 1] which was subsequently managed by surgery that is, excision of falciform ligament. While umbilical cord infections can occur in all settings, they are more likely to occur in low-income countries, where the majority of births take place at home in unclean settings and are not attended by a skilled attendant. The overall proportion of mortality related to local umbilical cord infections that become systemic is unknown, but exposure to pathogens, with or without the development of local signs of omphalitis is thought to be an important antecedent event in the pathway to sepsis and death in newborns.
Figure 1
Contrast-enhanced computed tomography of abdomen — hypodense lesion in falciform ligament
Contrast-enhanced computed tomography of abdomen — hypodense lesion in falciform ligamentDelivery at home, low birth weight, use of umbilical catheters, and septic delivery have been known to be risk factors of the omphalitis.[1] Methicillin resistant staphylococcus aureus has been reported to be the most frequent causative agent of omphalitis in children.[2]On abdominal examination, right upper quadrant pain, distension, and epigastric tenderness are common. Some cases may present with spiking fevers and leukocytosis in laboratory studies.[3] It is important to differentiate between falciform ligament abscess and hepatic abscess because antimicrobials are efficient in treating the latter while their utility in former conditions is dubious.[4]A soft tissue mass beneath the abdominal wall continuous with a thickened round ligament is a diagnostic feature of a falciform ligament abscess on USG or CT scanning. Many readily accessible abscesses are treated successfully with percutaneous drainage and antibiotics, but a successful treatment of the falciform ligament abscess is rather excision of the ligament itself.Internationally, the World Health Organization has advocated since 1998 for the use of dry umbilical cord and recommends topical antiseptics (e.g., chlorhexidine) in situations where hygienic conditions are poor and/or infection rates are high.[5]
Figure 1