A Strangulated Meckel’s Diverticulum in an Inguinal Hernia: A Case Report and Literature Review

Abstract

Background Meckel’s diverticulum is an embryologic remnant of the vitelline duct, occurring in approximately 2% of the adult population. A hernia containing a Meckel’s diverticulum is called a Littré’s hernia and is rarely reported in the medical literature. Clinically, a Littré’s hernia is indistinguishable from a hernia containing small bowel and is often discovered incidentally during a repair. Case Presentation Herein, we report a rare case of strangulated Littré’s hernia in a patient’s right groin. The sac contained a long segment of small bowel in addition to a large Meckel’s diverticulum. The bowel was irreducible through the groin incision, and a lower midline laparotomy was made. Necrotic bowel including the Meckel’s diverticulum was resected. Given the presence of necrotic bowel and potential for infection, the hernia was repaired with a Bassini herniorrhaphy, reinforced with absorbable mesh. The patient recovered uneventfully. Conclusion Littré’s hernia is a rare clinical entity. Treatment is similar to any bowel-containing hernia. Repair of the hernia defect with permanent mesh should be weighed against the risk of implant infection.

Umbilical Littre hernia: A rare case report of an acute abdomen

“…LH is an exceedingly rare complication of MD, first reported by French surgeon Alexis de Littré in the 1700s [ 2 ]. It results from the passage of an MD that could be associated with intestinal loops through a hernial defect.…”

“…Moreover, two distinct subtypes of LH can be defined: the more common “true LH” contains only MD and should be distinguished from Richter's hernia, where part of the intestinal wall is strangulated in the hernial sac, but no MD is involved. A “mixed LH” containing a segment of small intestine in addition to a MD is less frequently reported [ 2 , 3 ]. Its overall incidence is not yet precise, but it is reported that 1 % of patients with diverticulum will develop Littre's hernia.…”

“…LH usually result in an inguinal or femoral hernia and rarely in an umbilical hernia. It's an extremely rare condition with an unknown incidence [ 2 ]. A recent systematic review identified only 53 of these hernias published in the literature, most commonly in the groin (73 %) [ 3 ].…”

“…Surgery is the main treatment. Although the management of uncomplicated MD remains controversial, MD‘s managing in the setting of either bowel obstruction or of Littre's hernia is done according to clinical principles combined with the availability of local expertise [ 2 , 4 ]. In this work, a case of umbilical LH discovered during emergency management of obstructive syndrome, in an 11-year-old boy, was presented.…”

Obstructed Inguinal Littre’s Hernia: A Vague Presentation

“…11 The World Society of Emergency Surgery (WSES) 2017 emergency hernia surgery guidelines advocated the use of permanent mesh in a "clean-contaminated" type of field in order of low risk of infection and prevention of the recurrence. 12…”