Richter supraumbilical hernia managed with invagination: a case report

Area of Science:

• Gastroenterology
• Abdominal Surgery
• Hernia Repair

Background:

• Richter's hernia involves incarceration of the anti-mesenteric border of the bowel through an abdominal wall defect.
• It is increasingly associated with laparoscopic and robotic-assisted surgical procedures.
• The condition can affect any age group but is more common in the elderly, with a slight female predominance.

Observation:

• A case of Richter's hernia in a 40-year-old male post-laparoscopic cholecystectomy and kidney transplant is presented.
• The patient exhibited a 4-day history of irreducible supraumbilical swelling and abdominal pain.
• Intraoperative findings revealed a 1.5 cm hernia defect containing omentum and bowel segment.

Findings:

• Richter's hernia symptoms, including abdominal discomfort and nausea, can be delayed due to partial bowel wall involvement.
• Diagnosis is confirmed via computed tomography (CT) scan or intraoperative exploration.
• Invagination with serosal closure, such as the Mayo double-breasting technique, was performed for the incarcerated bowel segment.

Implications:

• Higher clinical suspicion for Richter's hernia is necessary, especially in patients with prior minimally invasive surgery.
• Prompt surgical intervention is critical for reducing mortality and improving prognosis.
• Invagination suffices for repair if ischemia is limited, negating the need for mesh placement.