Silver Sign or Falciform Ligament Sign in Pneumoperitoneum

Clinical Image The falciform ligament sign, also called the “silver sign” corresponds to the presence of air in the falciform ligament. The falciform ligament is more visible because it is moulded by the extra digestive air. The falciform ligament connects the liver to diaphragm and anterior abdominal wall. It is an indisputable argument in favour of massive pneumoperitoneum. Abdomen without preparation in the left lateral decubitus, horizontal radius shows the presence of air between the abdominal wall and the liver. An abdominal Computed Tomography sections show a free pneumoperitoneum silhouetted against the falciform ligament (Figures 1 and 2: red arrow). It can be seen in several contexts, i.e., perforations of the digestive tract, the aftermath after surgery (present case post cephalic duodeno pancreatectomy), anastomotic leakage, peritoneal puncture, endoscopy, biopsy, post-traumatic breach of the abdominal wall. The etiology must be researched according to the context with a view to appropriate management. Keywords: Silver sign-falciform; Ligament-CT-Pneumoperitoneum