Medical Case Reports

Abstract

Introduction: A hernia is defined as the protrusion of an organ through a muscle or tissue holding it in place. Littre’s hernia is a rare surgical entity and containing Meckel’ diverticulum. A Richeter’s hernia is when bowel wall partially herniated. We present a case of an elderly lady with the rare surgical presentation of having both hernias simultaneously.

Case study: An 84 year-old lady presented with signs and symptoms consistent with a small bowel obstruction. This is on the background of obesity, type 2 diabetes, ischaemic heart disease, and asthma. On examination she was hemodynamically stable, alert and orientated. Her abdomen was soft and non-tender with an easily reducible ventral hernia. She subsequently had a CT abdomen which showed a left side inguinal hernia which was not detected by the emergency or surgical staff due to the patient’s body habitus. She underwent open inguinal hernia exploration, and on opening the sac, a Littre as well as Richter’s hernia was revealed. The neck of the small bowel was deemed viable, so only a diverticulectomy of the Meckel’s diverticulum was performed. The hernia was subsequently repaired with a Lichtenstein technique. There were no significant postoperative complications, and patient was discharged on Day seven post operation.

Discussion: There is no published literature reported on combined Littre’s and Richter’s inguinal hernia. Given the potential high morbidity and mortality associated with Richter’s hernia, this condition should be included in the list of differential diagnosis.