The falciform ligament is a peritoneal fold extending from the anterior hepatic surface to the anterior abdominal wall and diaphragm. Although rare, pathological conditions affecting this structure exhibit significant variability.

We present various pathological findings and anatomical variations of the falciform ligament in both adult and pediatric populations, including congenital, tumoral, vascular, and infectious conditions, highlighting the significance of its anatomical position and intricate vascular and lymphatic connections in the pathogenesis of these conditions.

Tumors within the ligament can range from benign to malignant, with cysts and metastases being the most prevalent. Falciform ligament infarction, often underrecognized, may lead to unnecessary laparoscopic exploration. The ligament can be affected by surrounding infectious pathologies, potentially leading to abscess formation.

Congenital and iatrogenic defects may lead to internal hernias, potentially causing severe complications. Other congenital anomalies, such as ectopic anatomical structures or atypical ligament positioning, have been reported, emphasizing the complexity of its embryological development.