Background <p>Falciform ligament hernia (FLH) is an exceptionally rare internal hernia and an uncommon cause of small bowel obstruction. Its nonspecific presentation and subtle imaging findings make preoperative diagnosis difficult. We report a surgically confirmed case and summarize published cases identified through a comprehensive literature review.</p> Case Presentation <p>A 64-year-old Asian man presented with intermittent right upper abdominal pain and distension for five days. He had three similar self-limited episodes over the preceding 40 years and no history of abdominal surgery. Chest CT suggested old inactive pulmonary tuberculosis, although no previous diagnosis of tuberculosis had been established. After failed conservative treatment, diagnostic laparoscopy revealed a viable jejunal loop herniating through an approximately 4&#xa0;cm falciform ligament defect, with multiple intra-abdominal adhesions. The herniated bowel was reduced, adhesions were lysed, and the defect was closed. Histopathology of excised adhesions showed chronic adhesive peritonitis. No histological or microbiological evidence confirmed active or previous tuberculous peritonitis. The final diagnosis was small bowel obstruction related to chronic adhesive peritonitis and intra-abdominal adhesions, with a concomitant surgically confirmed FLH. The patient recovered uneventfully and remained recurrence-free during four years of follow-up.</p> Conclusion <p>Among 54 reported cases, FLH was correctly diagnosed preoperatively in 12 cases (22.2%), and bowel necrosis occurred in approximately 36.0%. FLH should be considered in selected patients with unexplained small bowel obstruction, especially when CT shows bowel loops or mesenteric vessels near the falciform ligament, hepatic round ligament, anterior abdominal wall, or liver surface. Early diagnostic laparoscopy may be useful in selected clinically stable patients.</p>