Port site Richter’s hernia. Case report and review

Abstract

The incidence of port site hernia (PSH) after a range of laparoscopic procedures has been variously reported as between 0.14% and 22%. In addition to pain, PSH may be associated with severe complications, including bowel obstruction, strangulation, and perforation. The case is reported of Richter’s hernia in a 45-year-old male at a 5 mm port site 6 years after laparoscopic cholecystectomy (LC).He presented with a lump in the right lumbar region associated with sudden onset pain and non-passage of stool for two days. With a diagnosis of PSH, he underwent exploratory laparotomy with a right lumbar skin incision, which revealed herniation of the omentum and part of the antimesenteric wall of a small bowel loop through the port site defect of about 1 x 1 cm. The gangrenous omentum was excised and the rest of the omentum and viable bowel loops were reposited. PubMed database search 1991 to 2016 showed an incidence of PSH ranging from 0.38% to 5.4% with an overall incidence of 1.7% in a review from 1995 to 2008. The umbilicus was the most common port to be associated with incisional hernia. It is rarely associated with strangulation or bowel obstruction. Not closing the fascial defect is thought to be implicated, although closing the fascia is not preventive. PSH at secondary port sites is very rare. Richter’s hernia with strangulation at a 5 mm port-site is the rarest presentation.