A case of Richter's hernia presenting after a previous inguinal herniorrhaphy

Abstract

Richter hernia also known as partial enterocele is the protrusion or/and strangulation of only a part of the circumference of the intestinal antimesenteric border through a small defect of the abdominal wall. These comprise around 10 percent of strangulated hernias, which itself represent a small percent in overall hernia cases, hence are very rare. If left untreated, the affected bowel segment becomes ischemic and finally gangrenous, and it should be kept in mind that patients with Richter hernia develop gangrene much faster than ‘ordinary’ strangulated hernias. This is a case report of a 69-year-old male with a history of herniorrhaphy for left inguinal hernia 22 years back presenting with swelling in left groin region for 4 days with sudden onset of left-sided acute abdominal pain and vomiting for 1 day. Ultrasound Abdomen suggested left sided obstructed inguinal hernia with enterocele with fatty liver. X-Ray abdomen showed multiple air fluid levels. The swelling was explored through incision located over it. Sac was identified and a Richter-type hernia was seen deep inside with small bowel strangulated only in a part of its circumference. Resection and anastomosis of approx. 10 cm was done for the gangrenous part and gut reduced back into abdominal cavity and sac closed. Richter’s hernia is associated with a strikingly high death rate which emphasizes the seriousness of this condition. Once the diagnosis is made, urgent operation must be carried out to avoid morbidity and mortality.