Richter hernias are an abdominal hernia where only a portion of the bowel wall is herniated and comprise 10% of strangulated hernias. These hernias progress more rapidly to gangrene than other strangulated hernias but obstruction is less frequent.
In contrast to most other types of hernia, only the antimesenteric wall of the bowel herniates without compromising the entire lumen. This herniation is usually through a small, firm defect in the abdominal wall. The part of bowel most often trapped is the terminal ileum; however, any part of the bowel can be involved.
Richter hernias can occur at 2:
- femoral ring (36-88%)
- inguinal ring (12-36%)
- abdominal wall incisional hernia (4-25%)
- rare: umbilical, ventral, Spigelian, supravesical, sacral foramen, triangle of Petit, retrosternal, and diaphragmatic hernias
- trocar ports for laparoscopic surgery
Venous circulation of the incarcerated hernia is impaired, which can result in bowel infarction and gangrene. Perforation into the hernial sac can progress to an enterocutaneous fistula if left untreated. If perforation occurs after the necrotic segment has receded into the abdomen, then abscess formation or even faecal peritonitis could be the sequelae 1.
A focal protrusion of the antimesenteric wall of a bowel loop into a small defect in the abdominal wall.
Ultrasound can identify the fascial defect as well as the part of the bowel that enters the hernial sac.
History and etymology
The first description was given by German surgeon August Gottlieb Richter in 1778 in his "Treatise on the Ruptures", but the first case was described by Fabricius Hildanus as early as 1606 2.
- 1. Steinke W, Zellweger R. Richter's hernia and Sir Frederick Treves: an original clinical experience, review, and historical overview. Annals of surgery. 232 (5): 710-8. Pubmed
- 2. Skandalakis PN, Zoras O, Skandalakis JE et-al. Richter hernia: surgical anatomy and technique of repair. Am Surg. 2006;72 (2): 180-4. Pubmed citation