Littre Hernia: Surgical Anatomy, Embryology, and Technique of Repair

Abstract

Littre hernia is the protrusion of a Meckel diverticulum through a potential abdominal opening. Alexis de Littre (1700) reported ileal diverticula and attributed them to traction. August Gottlieb Richter (1785) defined them as preformed, and Johann Friedrich Meckel (1809) postulated their embryologic origin. Sir Frederic Treves (1897) distinguished between Littre and Richter hernia (partial enterocele). Embryologically, Meckel diverticulum is the persistent intestinal part of the omphaloenteric duct through which the midgut communicates with the umbilical vesicle until the fifth week. It is found at the antimesenteric border of the ileum, usually located 30 to 90 cm from the ileocecal valve, measuring 3 to 6 cm in length and 2 cm in diameter. Usual sites of Littre hernia are: inguinal (50%), umbilical (20%), and femoral (20%). Meckel diverticulum may be accompanied in the sac by the ileal loop to which it is attached; rarely, it may undergo incarceration or strangulation, necrosis, and perforation. In children, it is mostly found in umbilical hernias, and the diverticulum is more prone to adhere to the sac. Repair of Littre hernia consists of resection of the diverticulum and herniorraphy; in perforated cases, care must be taken to not contaminate the hernia field.

Littre's hernia- a rare case of a strangulated Meckel's diverticulum

“…Since then Littre's hernia has been described as occurring at the inguinal, umbilical, and femoral sites. 2 While this incarceration of a Meckel's diverticulum is well described, it is exceedingly rare with less than 50 cases reported in the 300 years ensuing the initial description. 3 The management of Littre's hernia consists of resection of the diverticulum, anastomosis of bowel, followed by herniorrhaphy (or herniotomy in children).…”

Meckel's Diverticulum Perforation Due to Strangulated Inguinal Hernia (Littre's Hernia): A Rare Case

“…In perforated cases, care should be taken not to contaminate the field. 2 Linear staplers can be safely used in diverticula with a height-diameter ratio of more than 1.6, but if the basic of diverticulum is broad or lenght of diverticulum is insufficient for applying stapler, it is contraindicated to use stapler for excision because of the risk of leaving heterotopic tissue. 7,8 S So ou ur rc ce e o of f F Fi in na an nc ce e During this study, no financial or spiritual support was received neither from any pharmaceutical company that has a direct connection with the research subject, nor from a company that provides or produces medical instruments and materials which may negatively affect the evaluation process of this study.…”

Incarcerated Littre’s hernia: uncommon presentation of Meckel’s diverticulum

“…Incarceration of the incarceration of LH is a very rare condition and it is reported that the incidence in various case series is between 0.6-0.8%. In a serie of Mayo Clinic, among the 1476 cases, incarceration was reported in only 2 cases [5][6][7][8][9]. It may not be possible to make diagnosis of incarcerated LH preoperatively.…”