Strangulated richter's hernia with caecum necrosis. Case report
Annali Italiani Di Chirurgia
|September 27, 2021
Summary
This case report details a rare Richter's femoral hernia with caecum incarceration, highlighting the critical need for prompt surgical intervention in emergency hernia repair to prevent bowel necrosis.
Area of Science:
- General Surgery
- Abdominal Wall Reconstruction
- Hernia Surgery
Background:
- Femoral hernias are rare, comprising 2-4% of groin hernias, with a high risk of incarceration and strangulation due to the narrow femoral canal.
- Richter's hernia, a specific type involving protrusion of only part of the bowel circumference, can present with non-specific symptoms, delaying diagnosis.
- Bowel necrosis and emergency surgery are significant risks associated with incarcerated femoral hernias.
Observation:
- A 46-year-old woman presented with acute right lower quadrant abdominal pain and an irreducible lump, initially diagnosed as a right inguinal hernia on CT scan.
- Surgical exploration revealed a Richter's femoral hernia with incarcerated and necrotic caecum wall, though the appendix was unaffected.
Findings:
- The surgical management included a mini-laparotomy for tangential caecal resection and appendectomy.
- Repair of the femoral defect was achieved using a polypropylene mesh-plug placed in the pre-peritoneal space.
- The patient experienced an uneventful recovery and was discharged on postoperative day five.
Implications:
- Caecum wall necrosis secondary to incarcerated Richter's femoral hernia is a rare but life-threatening surgical emergency.
- Prompt surgical exploration is mandatory for incarcerated hernias with suspected bowel strangulation or perforation.
- The choice of surgical approach (open or laparoscopic) depends on surgeon expertise, with prosthetic mesh use recommended for defect repair.
