Richter's type strangulated femoral hernia containing caecum and appendix masquerading as a groin abscess

Abstract

Femoral hernias are challenging conditions, not only because their diagnosis is often missed, but also because if left undiagnosed and untreated, their complications are severe and often life-threatening. The authors present the second reported case of a femoral hernia of the Richter’s variety containing caecum and appendix that, following strangulation and perforation, manifested as a groin abscess.

Strangulated Richter's incisional hernia presenting as an abdominal mass with necrosis of the overlapping skin. A case report and review of the literature

“…It is a rare type of hernia with the femoral ring being the most common site of development (71–88%). Other encountered locations are the inguinal canal (23–24%) and the abdominal wall (4–6%), usually after abdominal incisions . Hernias of the Richter type usually involve the terminal ileus, but other parts of the gastrointestinal tract can also become incarcerated .…”

“…Other encountered locations are the inguinal canal (23–24%) and the abdominal wall (4–6%), usually after abdominal incisions . Hernias of the Richter type usually involve the terminal ileus, but other parts of the gastrointestinal tract can also become incarcerated . Approximately 6% of all strangulated hernias are of the Richter type .…”

“…Strangulation of the bowel wall compromises its blood perfusion and causes ischemia. This can lead to gangrene and bowel perforation, further resulting in peritonitis or the creation of a subcutaneous abscess . Open surgery or laparoscopy methods are viable for treatment.…”

Richters Hernia-A Rare Phenomenon in Surgery

“…While rare, the condition is not so rare as to be merely a curiosity. For such a hernia to form, there are two key pre-requisites: first of all, the hernia orifice must Richters Hernia-A Rare Phenomenon in Surgery DOI: 10.9790/0853-1509143536 www.iosrjournals.org 36 | Page be large enough to ensnare the bowel wall, but too small to contain an entire loop of intestine; second, the margin of the hernia ring must be firm (which predisposes to strangulation) [5,6]. If left untreated, the affected bowel segment becomes ischemic and finally gangrenous; in this respect, it should be noted that a higher number of patients with Richter's hernia develop gangrene, as compared to 'ordinary' strangulated hernias.…”

A Rare Case of Richter’s Variety of Obstructed Femoral Hernia in a Male

“…In the first place, femoral hernia in a male patient is itself, a very rare clinical presentation, let alone complications like obstruction or strangulation in the second place. Thus, despite the fact that femoral hernias account for only 2-4 % of all groin hernias, their timely and correct diagnosis is vital due to the increased mortality associated with emergency surgery for their complications [Arkoulis et al (2012) Ox J Med, J Surg Case Rep 2012(6):6]. This, however, is not always easy, where mortality has been found to be tenfold.…”