The falciform ligament is a sickle shape peritoneal ligament, derived from the dorsal mesentery, that connects the anterior part of the liver to the ventral wall of the abdomen. Abscess of the ligamentum exists is described in the medical literature a a rare phenomenon, whose pathophysiology, while poorly understood often occurs as a consequence of local inflammatory process. An 80-year-old female was admitted for delirium, epigastric pain with obstructive jaundice. Her lipase was elevated, and she had deranged liver function tests with elevated serum bilirubin. A non-contrast CT abdomen and pelvis was performed, due to the patient’s acute kidney injury, which showed choledocholithiasis and fat atrophy of the pancreas. A follow-up abdominal ultrasound showed mobile gallstones, with no features of cholecystitis. She underwent endoscopic retrograde cholangiopancreatography (ERCP) with a small sphincterotomy and placement of double pigtail stent in the common bile duct. A non-contrast CT scan was performed to investigate her persistently elevated CRP which showed an anterior abdominal wall, which was subsequently drained with ultrasound guidance. Follow-up imaging showed re-accumulation of the collection. The patient proceeded to undergo a laparoscopic cholecystectomy, which showed the abdominal wall collection tracking along the falciform ligament. The abscess was drained and the falciform ligament was resected. A CT showed re-accumulation of the collection, which was subsequently drained and grew multi-resistant Enterococcus faecium. She was discharged at day 30 post-admission. This case demonstrates the unusual history of a falciform ligament abscess, highlighting the uncertainty relating to the mechanism.