A CASE OF RIGHT INGUINAL RICHTER HERNIA ASSOCIATED WITH HETEROTAXIA

Abstract

We report on a case of Richter hernia associated with heterotaxia in a 55-year-old woman who visited with the chief complaint of right lower abdominal pain. At the first visit, tenderness at the ileocecal region. Blumberg sign, and tenderness at the right upper region of the pubic bone were noted, but no tumor was palpated. A diagnosis of acute appendicitis was made based on the clinical course after the onset of the symptoms and leukocytosis. However, thoracico-abdominal simple X-ray examination and abdominal ultrasonography revealed a right thoracic cardiac situs inversus. The patient was diagnosed as intestinal obstruction caused by unknown origin of the right lower abdominal region. Laparotomy findings showed a right incarcerated inguinal hernia, in which a part of the small intestinal wall was strangulated with the right internal inguinal ring. After reduction of the small intestine, radical operation for hernia without enterectomy could be performed. The patient was discharged on the 17th day after surgery.In this country 1037 cases of heterotaxia were reported from 1889, when Kasahara first reported, to 1980. This time we analyzed 250 domestic cases accumulated from 1981 to 1990. We think that the disease, which can be found by various medical checkups, but patients themselves often lack of understanding it as a disease, offers a diagnostic problem that surgions are also liable to overlook at the first diagnosis.