Introduction: Falciform ligament (FL) abscess is uncommon in adults and can occur in the context of acute cholangitis, acute pancreatitis, torsion of the FL itself or spontaneously. Abdominal imaging often helps making a correct diagnosis.
Case Presentation: We report a case of an adult male patient who developed appendagitis of the FL in the context of acute pancreatitis secondary to hypercholesterolaemia. Abdominal computed tomography (CT) scan confirmed the initial diagnosis but condition evolved towards the formation of FL abscess. Clinical and radiological follow-up raised the suspicion of extrahepatic bile duct tumour; given the diagnostic uncertainty, the patient underwent diagnostic laparoscopy. That allowed for correct diagnosis and treatment. A review of recent literature is also reported.
Conclusions: FL abscess is uncommon in adults and radiological findings can be misinterpreted as other clinical conditions; a high index of suspicion is required to formulate a correct diagnosis with the aid of diagnostic laparoscopy.