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Perineal Richter's herniation following proctectomy

H Jayamanne1, B M Stephenson1

  • 1Department of Surgery, Royal Gwent Hospital, Newport , Wales , UK.

Annals of the Royal College of Surgeons of England
|October 13, 2017
PubMed

Insights

Richter's hernia, a rare condition where only part of the bowel wall incarcerates, can occur years after proctectomy. A high index of suspicion is crucial for timely diagnosis in patients with functioning stomas.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Abdominal Surgery

Background:

  • Richter's hernia is a specific type of strangulated external hernia involving only the anti-mesenteric border of the small bowel.
  • Proctectomy is a surgical procedure involving the removal of the rectum, often performed for conditions like rectal cancer or inflammatory bowel disease.

Observation:

  • This report details three cases of Richter's hernia presenting in patients following proctectomy.
  • The time interval between proctectomy and hernia presentation ranged from 18 days to 11 years.
  • All three patients had functioning stomas, complicating the initial clinical suspicion.

Findings:

  • Delayed diagnosis of Richter's hernia can occur even in patients with stomas, necessitating a high index of suspicion.
  • The varied presentation timeline highlights the potential for late-onset complications after proctectomy.
  • Early recognition is critical to prevent potential bowel compromise.

Implications:

  • Clinicians should maintain a high index of suspicion for Richter's hernia in patients with a history of proctectomy, irrespective of stoma function.
  • Prompt diagnosis and surgical intervention are essential to minimize morbidity associated with incarcerated Richter's hernia.
  • This case series underscores the importance of vigilant long-term follow-up for patients who have undergone proctectomy.

Keywords:
Cancer of caecumNecrotising fasciitis

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