Presentation
Abdominal pain and vomiting. Normal physical examination of hernial orifices.
Patient Data
Incarcerated right inguinal hernia causing great retrograde distension of the small bowel. No distension of the terminal ileum or the colon. Free fluid in the Douglas pouch.
Small incarcerated right inguinal hernia (arrows) causing small bowel distension. Associated free fluid in the Douglas pouch.
Per-operative photo showing the incarcerated antimesenteric margin of a small bowel loop that was herniated through the right deep inguinal ring.
Case Discussion
Richter hernia is a type of incarcerated hernia with strangulation of the antimesenteric portion of the intestinal wall. It is a very rare manifestation so its diagnosis remains difficult 1, like in our case where the physical examination by the surgeon was normal.
The most common sites are the femoral and inguinal regions 2 and these hernias rarely obstruct due to lesser degree of impingement of the lumen, which was the case in this patient.
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