Richter’s Hernia and Sir Frederick Treves: An Original Clinical Experience, Review, and Historical Overview

Abstract

Richter's hernia is a deceptive entity whose high death rate can be reduced by accurate diagnosis and early surgery. Considering the increasing incidence at laparoscope insertion sites, awareness of this special type of hernia with its misleading clinical appearance is important and of general interest.

Iatrogenic uterine perforation resulting in Richter's hernia: a rare complication of dilatation and curettage

“…This is probably the first description of Richter's hernia in the literature [3]. With the advancement of laparoscopic surgery and the use of large ports (10 mm or more), an increase of Richter's hernia at trocar sites has been reported [4,5]; however, Richter's hernia is rarely mentioned in the literature of gynecology.…”

“…Richter's hernia is defined as "an abdominal hernia in which only part of the circumference of the bowel is entrapped in the hernial orifice" [3]. This will result in a rapid progression of the involved intestine to strangulation and perforation.…”

A case of Richter's hernia presenting after a previous inguinal herniorrhaphy

“…2 The patient would usually present initially with innocuous symptoms and little clinical findings which may include vague abdominal pain and malaise. 5 Although the patient may have nausea and vomiting but it would be less severe than what is present in cases of strangulated hernias. 5 The most common clinical finding is tenderness and swelling over the hernia orifice; if there is local gangrene of the intestinal wall then the overlying skin may be inflamed, which would often lead to misdiagnosis as a local abscess.…”

“…5 Although the patient may have nausea and vomiting but it would be less severe than what is present in cases of strangulated hernias. 5 The most common clinical finding is tenderness and swelling over the hernia orifice; if there is local gangrene of the intestinal wall then the overlying skin may be inflamed, which would often lead to misdiagnosis as a local abscess. 1 Often an enlarged lymph node in Richter's hernia of the femoral canal may be misdiagnosed as acute lymphadenitis.…”

“…It is deceptive because the strangulation may start early and often there is absence of obstructive symptoms. 5 The high mortality which is found in this has mainly resulted from misdiagnosis, delayed diagnosis and/or delayed operation.…”