Richter hernia: incarcerated with subacute small bowel obstruction

Case contributed by Mohammad A. ElBeialy
Diagnosis certain


Abdominal pain and vomiting since three days. Diabetic and hypertensive patient with recent history of exploratory laparotomy.

Patient Data

Age: 74 years
Gender: Male

Incarcerated Richter hernia with  focal herniation of the antemesenteric border of the proximal ileal loops are seen along the linea semilunaris with moderate dilatation of the stomach and proximal small bowel loops with feculent type material within (small bowel feces sign).  No definite obstructing mass lesion is identified.  The bowel loops show normal wall thickness with normal enhancement with no definite CT evidence of vascular compromise or ischemic bowel necrosis, no pneumatosis intestinalis or evidence of pneumoperitoneum. Swirling of the superior mesenteric vessles is noted with "whirl sign" of the tightly twisted mesentery. The distal bowel loops are seen collapsed.

Mild amount of abdominal and pelvic fluid collection is noted.

The prostate is mildly enlarged with intact prostatic capsule as well as homogeneous parenchyma with small prostatic concretions.

Spondylotic changes of the dorsolumbar spine with 1st degree degenerative anterolisthesis L4 over L5.

Incarcerated incisional Richter Hernia with the antemesenteric border of the proximal ileal loop is seen herniated along the linea semilunaris with incarceration and proximal small bowel obstruction. 

Case Discussion

Incarcerated Richter hernia with subacute small bowel obstruction. No evidence of vascular compromise or bowel ischemia is note.  The patient was operated and reduction of the incarcerated small bowel loop herniation was done. 


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