Unusual Richter's Hernia: Impacted foreign body leading to incarceration and perforation - A rare clinical entity

Abstract

Introduction & importance: Richter's hernia is a clinically deceiving entity as is particularly associated with high morbidity and mortality which can be can be abated by timely diagnosis and surgery. Direct inguinal hernias having a wide neck have lesser chances of incarceration and strangulation when compared to indirect inguinal hernias. The knowledge about this type of hernia is especially important in the context of laparoscopy as majority of the laparoscopic port site hernias are characteristically Richter's type in configuration. The objective of this report is to highlight the unusual presentation of the case and sine quo non of prompt diagnosis and timely surgery remains the cornerstone of management.

Case presentation: We report a case of Richter's hernia incarcerated due to an impacted foreign body (match stick) through a direct inguinal hernia. Patient presented with a painful, non-expansile, tender swelling in left groin. Patient was diagnosed with a complicated inguinal hernia and underwent exploration with resection of involved bowel segment and primary repair of hernia.

Clinical discussion: Richter's hernia is a rare abdominal wall hernia specifically known for its unusual and delayed presentation leading to high rates of morbidity and mortality. Direct inguinal hernias are less prone to complications like obstruction, strangulation and incarceration owing to presence of a wide neck. Clinical suspicion, prompt radiological diagnosis and timely surgery can lead to an uneventful recovery.

Conclusion: Surgery is the only treatment, but timely surgery remains the golden opportunity. Critical in repair is the evaluation of intestinal viability.

Keywords: Case report; Foreign body; Incarcerated hernia; Richter’s hernia; Unusual hernia.