The falciform ligament is a thin, sickle-shaped peritoneal fold connecting the anterior liver to the anterior abdominal wall and diaphragm, containing the ligamentum teres (obliterated umbilical vein) in its free edge.
Suspends the anterior liver from the anterior abdominal wall, maintains liver position, provides the surgical landmark dividing the left and right functional liver lobes (Couinaud segments), and contains the obliterated umbilical vein used for portal access.
The falciform ligament divides the liver's functional anatomy — left of the falciform contains segments II and III, right contains segments IV-VIII. It is divided in liver resection and liver transplantation. In portal hypertension, paraumbilical veins within the falciform ligament recanalize, producing the caput medusae sign.
Portal hypertension causing recanalization of the paraumbilical veins within the falciform ligament, producing the visible radiating abdominal veins from the umbilicus (caput medusae sign) in cirrhosis.
The falciform ligament marks the boundary between Couinaud liver segments II-III (left) and IV (right), guiding the anatomic plane for left lateral sectionectomy.
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