Spontaneous Entero-Cutaneous Fistula due to Femoral Hernia: A Case Report

An enterocutaneous fistula is an aberrant connection between the intra-abdominal gastrointestinal tract and skin/wound. Spontaneous enterocutaneous fistula secondary to femoral hernia is extremely rare but may be life-threatening because of sepsis, malnutrition and stuid-electrolyte imbalance. We report an 83-year-old woman who presented with a short history of irreducible right groin swelling associated with feculent discharge. Contrast-enhanced computed tomography revealed a perforated distal ileal loop within a right femoral hernia, forming an enterocutaneous fistula. She underwent emergency laparotomy, segmental ileal resection with Meckel's diverticulectomy, primary ileo-ileal anastomosis and hernia repair without mesh. Her postoperative recovery was uneventful and she remains well on follow-up. This case highlights the need to consider femoral Richter's hernia with spontaneous enterocutaneous fistula in elderly women presenting with atypical groin discharge, and supports early imaging and definitive surgery to prevent morbidity.