Richter's Hernia With Bowel Perforation in the Umbilical Region: A Unique Pediatric Case

Richter's hernia is a rare condition in which only a portion of the bowel's antimesenteric border becomes incarcerated, often leading to ischemia and perforation without complete obstruction. While commonly seen in elderly patients, pediatric cases, especially congenital umbilical presentations, are rare. We present a case of a four-year-old female with a three-day history of crampy peri-umbilical pain, a non-reducible right paraumbilical bulge, and intermittent vomiting. Despite the patient continuing to pass stool, intraoperative findings revealed an entrapped antimesenteric side of the distal ileal loop, confirming Richter's hernia with a perforation inside the hernia sac. The perforation was debrided and closed with primary suturing. The hernia was repaired using a double-layer anatomical closure, and the postoperative course was uneventful. This case highlights the deceptive nature of Richter's hernia and the importance of early recognition, particularly in pediatric congenital umbilical hernias, to prevent severe complications.