Richter's hernia at a Tenckhoff catheter exit site

A 60-year-old male presented with a 2-day history of nausea, vomiting, and abdominal pain 3 months after kidney transplantation. No clinical and x-ray signs of small obstruction were present. A CT scan of the abdomen showed incarcerated small bowel loop at the site of the earlier peritoneal dialysis catheter (Tenckhoff) that was removed 2 months before. The hernia was repaired by laparoscopic approach using a biologic mesh. Only a few cases of small bowel obstruction at the Tenckhoff catheter exit site have been reported in the literature but none, to our knowledge, has described a case of partial small obstruction (Richter's hernia). The presentation of Richter's hernia can be very deceiving, especially in transplanted patients because of the masking effects of immunosuppression on symptoms and signs of inflammation and difficult differential diagnosis in these patients.