Sickle Ligament: Definition, Location, Composition, Function and Associated Diseases

It is a band of tough fibrous tissues that attach part of the liver to the abdominal wall and the diaphragm.

This sickle-shaped ligament is a remnant of the ventral mesentery of the fetus.

The base of the falciform ligament descends backwards and downwards, while its apex goes backwards and upwards. The sickle ligament looks down from the helium of the liver.

Location of the falciform ligament

The falciform ligament lies in an anteroposterior plane, but the forward-facing surface is obliquely in contact with the peritoneum.

The peritoneum is the smooth transparent serous membrane that lines the orifice of the abdomen and folds inward over the abdomen and viscera, behind the right rectus abdominis muscle and the diaphragm, and the other is directed backwards and is in contact with the part left liver.

It is attached by its left border to the lower surface of the diaphragm and the posterior surface of the right rectus sheath as low as the umbilicus, by its right border it extends from the notch in the anterior margin of the liver, far behind as the posterior surface .

Composition of the sickle ligament and blood supplies

The ligament is made up of two mesothelial layers, which contain the hepatic round ligament, paraumbilical veins, muscle fibers, and a certain amount of adipose tissue. Two layers are closely together.

Its base is formed by layers of the round ligament, which is the ligament that divides the left part of the liver into internal and lateral sections, and the paraumbilical veins, small veins that establish an anastomosis between the veins of the anterior abdominal wall and the liver. portal, hypogastric and iliac veins.

The best marking of these small veins is the one that begins at the umbilicus and goes back and up, or on the surface of the round ligament between the layers of the falciform ligament to end at the left portal vein.

The falciform ligament is a leftover from the umbilical vein, which is a vein present during fetal development that carries blood with oxygen from the placenta to the fetus and a derivative of the embryonic ventral mesentery.

Function of the falciform ligament

The main function of this ligament is to hold the liver in position. It is one of the anatomical structures that attaches to the rectum and the wall of the diaphragm and prevents the liver from falling out of place.

The liver held in position by the sickle cell has many functions. The most notable include the synthesis of proteins, the detoxification of various metabolites, the production of unavoidable substances that are required for digestion, etc.

This digestive gland is responsible for producing bile, which is an alkaline compound used to digest food.

Therefore, it can be said that if the falciform ligament does not hold the liver in position, the main functions of the body would fail.

Diseases of the sickle ligaments

When it comes to the disease, the most common pathologies include ligament cysts, tumors and vascularity that are not normal, secondary to portal hypertension.

In addition, the most recognized abnormalities of the falciform ligament are congenital pathologies that include shunt and partial ligament defects.

It is well known that the arterial supply of the falciform ligament comes from a branch of the thin bundle of the right hepatic artery, which anastomoses to the superficial inferior epigastric artery. In many cases, a bile duct can be located in the ligament.

Venous drainage goes directly to the paraumbilical vein and portal vein, while lymphatic drainage flows directly into the retroperitoneum.

Sickle ligament tumors are rare and mostly benign and rarely malignant. These tumors are generally associated with a syndrome called tuberous sclerosis.

Small tumors may not present any signs or symptoms, while large tumors may compress surrounding organs and structures and cause pain and mass effect. Since the liver is involved, the result can be abdominal pain, weight loss, and bleeding.

Usually a surgical intervention of the tumor with all its removal is derived. The prognosis for benign falciform ligament tumor is very good if it is completely removed, in many cases.

The prognosis of malignant tumors depends on several factors, such as the stage of the tumor and the health of the patient.

Symptoms of portal hypertension

  • Gastrointestinal bleeding.
  • Black stools, blood in vomit from persistent bleeding and ruptured varicose veins.
  • Decreased levels of platelets that are responsible for forming blood clots or white blood cells. It should be noted that white blood cells help fight infection.
  • Poor liver function causing forgetfulness and confusion or encephalopathy.
  • Ascites (or fluid buildup in your abdomen).

Causes of portal hypertension

The main reason for portal hypertension is attributed to liver cirrhosis. So what is cirrhosis? It is a medical condition that causes scarring of the liver caused by reasons such as alcohol, hepatitis, and other liver damage.

When a person suffers from cirrhosis of the liver, the scarred tissues obstruct the flow of blood to the liver.

In many cases, the reason for portal hypertension is unknown. However, the other cause includes blood clots developed in the portal vein that help carry blood from your liver to the heart.

Another major cause is a type of parasitic infection known as schistosomiasis. Focal nodular hyperplasia is another important cause of portal hypertension.

Diagnosis of portal hypertension

The doctor performs a physical exam of the anus or abdomen that helps in the diagnosis of portal hypertension. The disease is detected on the basis of varicose or dilated veins or ascites.

Various other tests such as X-ray tests, laboratory tests, and endoscopic examinations are carried out to diagnose the disease.

Treatment of portal hypertension

There are several treatment options available to cure portal hypertension. They include medications, diet, surgery, endoscopic therapy, radiology procedures, and surgery.

The type of treatment chosen by the doctor depends on the severity of the symptoms and the liver function of the patient.

The types of treatments include:

Medications: Non-selective beta-blockers along with endoscopic therapy help reduce blood pressures and the risk of bleeding in varicose veins.

Prescribed beta-blockers help prevent variceal bleeding. The drug lactulose and the esophageal variceal band are the other two cures.

Endoscopic therapy: The procedure includes sclerotherapy or bands that use an elastic band to prevent blood vessels from bleeding.

The sclerotherapy process uses a blood clotting solution to inject into bleeding varicose veins.

You must incorporate some lifestyle changes to combat portal hypertension. Maintaining a healthy lifestyle and following good nutritional habits ensure that portal hypertension is avoided.

Do this to keep your liver working properly:

  • Avoid taking over-the-counter medications. Consult a doctor to make sure what kinds of medications should and shouldn’t be taken.
  • Avoid using illegal drugs or alcohol.
  • Include low sodium or low salt content in your diet. Based on your doctor’s advice, you may be instructed to have a maximum of 2 grams of sodium per day. You may also be advised to reduce your protein intake.
Other treatments are:

Distal splenorenal shunt : The procedure includes connecting the spleen vein and then the left kidney. This is to help reduce pressure on varicose veins and also control bleeding.

Transjugular intrahepatic portosystemic shunt : Your doctor places a stent right in the center of your liver, connecting the hepatic vein to the portal vein. This helps redirect blood to your liver, thereby reducing unnecessary pressure pressure on the abnormal veins.

Liver transplant : When a person has end-stage liver cancer, transplantation is the only option.

Paracentesis: In this process, the accumulation of fluid in the abdomen is removed. However, the procedure must be repeated and the patient must undergo several visits to the clinic.

Devascularization: the procedure removes bleeding varicose veins.

It goes without saying that the falciform ligament is an important ligament that helps hold the liver in position. Any disease caused to the sickle ligament must be diagnosed and evaluated by the doctor to ensure proper treatment.

Frequently asked questions about the falciform ligament

How does the falciform ligament help in the diagnosis of pneumoperitoneum?

This liver ligament plays a central role in determining the pneumoperitoneum in patients. Pneumoperitoneum is a medical condition in which air or gas enters the abdominal cavity and causes complications.

This band of tough fibrous tissues often shows symptoms of warping, bulging, or displacement if a person suffers from pneumoperitoneum.

Sickle ligament cysts

In rare cases, a ligament cyst develops leading to extreme pain in the upper abdomen. The most common form of treatment for such cysts is surgery as they do not respond to other forms of treatment.