RICHTER'S HERNIA: A DECEPTIVE CLINICAL ENTITY PRESENTING AS INTESTINAL OBSTRUCTION.

Abstract

Introduction: Richter's hernia is a rare entity representing a small percentage of all hernia cases. These are small fascial defects that entrap partial circumference of the bowel and vary in presentation with associated increases in morbidity and mortality. Case Report: A 78-year male presented with Richter's hernia of the umbilical region which was diagnosed intra-operatively. The content was the ileal wall with pre-gangrenous changes. Because of doubtful viability resection of the segment and end-to-end anastomosis was done. The postoperative period was uneventful. Discussion: In female and old age patients, Richter's hernia is common with the femoral and inguinal regions being the common sites. The presentation may vary from vague pain abdomen and swelling to gangrene and perforation peritonitis. Some patients present as intestinal obstruction while in some cases the presentation mimics acute gastroenteritis. Radiological investigations like X-ray, ultrasonography (USG), and CT (computed tomography) scan aid in diagnosis but most of the time diagnosis is made intraoperatively. Surgical reduction or resection is often warranted depending on the viability of entrapped segment. Conclusion: To diagnose and manage this deceptive clinical entity experience and expertise is required. Timely taken decision and intervention helps to reduce morbidity and mortality associated with it