Inflammation and necrosis of the hepatic round ligament in a postpartum patient: a rare case report.

Hepatic round ligament necrosis is a rare etiology of acute abdomen and should be considered in unexplained right upper quadrant pain when common biliary pathology is absent. Preoperative diagnosis is challenging, and confirmation is usually intraoperative. We report the case of a 28-year-old postpartum female presenting twice to our emergency department with recurrent biliary colic. Initially, the patient was diagnosed with uncomplicated cholelithiasis and was discharged. Two weeks later, she returned with persistent biliary colic symptoms and biochemical abnormalities and was scheduled for laparoscopic cholecystectomy. Intraoperatively, extensive inflammation unrelated to the gallbladder necessitated conversion to open surgery. The patient underwent open cholecystectomy and round ligament resection. Histopathology confirmed necrosis with inflammatory infiltration of the ligament. Laboratory readings normalized postoperatively, and the patient was discharged on Day 3. We hypothesize that ascending infection related to postpartum omphalitis, along with pregnancy-related hypercoagulability, may have contributed to HRL necrosis.