Complicated Littre's umbilical hernia with normal Meckel's diverticulum: A case report and review of the literature

Abstract

Introduction and importance A Littre's hernia (LH) is defined by the presence of Meckel's diverticulum (MD) in any kind of hernia sac. Preoperative diagnosis of LH is a challenge because of its rarity and the absence of specific radiological findings and clinical presentation. Surgery is the appropriate treatment of complicated LH that is an extremely rare condition with approximately 50 cases reported in the literature over the past 300 years. Case presentation A 46-year-old Caucasian female was admitted to the Emergency Department with a two-day history of abdominal pain. Physical examination revealed an irreducible and painfull mass in umbilical region. Abdominal computed tomography scan showed the protrusion of greater omentum and small bowel loop through the umbilical ring. Laboratory tests were unremarkable. After diagnosis of strangulated umbilical hernia, the patient underwent exploratory laparotomy: the irreducible umbilical hernial sac was opened with presence of incarcerated and strangulated omentum and uncomplicated MD. Resection of incarcerated and ischemic greater omentum alone was performed. The postoperative course of patient was uneventful. Clinical discussion Meckel's diverticulum (MD) is a vestigial remnant of the omphalomesenteric duct, representing the most common congenital malformation of the gastrointestinal tract. Preoperative diagnosis of LH is very difficult and surgery represents the correct treatment of complicated LH. Conclusion LH represents an extremely rare complication of MD difficult to diagnose and suspect because of the lack of specific radiological findings and clinical presentation. Surgery represents the appropriate treatment of abdominal wall hernias and complicated MD.

Management of Littre Hernia—Case Report and Systematic Review of Case Reports

“…In regards to hernia location, previous studies report the majority of Littre hernia occurring in the inguinal region, followed by the femoral and umbilical regions, whereas our review portrays a majority of cases in the femoral region, followed by the inguinal and umbilical regions [2,[9][10][11].…”

“…Most MDs remain asymptomatic [2]. The clinical manifestations of Littre hernia can range from abdominal pain and signs of intestinal obstruction up to enterocutaneous fistula.…”

“…One important aspect that we wanted to address was treatment. A number of authors have decided to preserve the Meckel diverticulum and not resect it, and one study has published recommendations for when to resect, but these articles fail to follow up with long-term surveillance [2,[16][17][18]. Since long-term follow-up is lacking, the outcomes of the preservation of the MD cannot be assessed.…”

“…Meckel's diverticulum (MD) is a saccular formation present in the lower part of the intestine, and it is considered one of the most common congenital anomalies of the gastrointestinal tract [1,2]. It results from embryologic closure failure of the omphalomesenteric duct [3].…”

“…It results from embryologic closure failure of the omphalomesenteric duct [3]. The protrusion of MD in a hernia sac is called a Littre hernia [2]. The name traces its origins to Alexis Littre, who first described this disease in the 18th century.…”