Stenosis of the small intestine after reduction of strangulated Littre hernia in an infant

Littre's Hernia Incidentally Found During Laparoscopic Indirect Inguinal Hernia Repair in a Child

Littre's hernia is a rare type of hernia in which Meckel's diverticulum is found in the hernia sac. While most cases present with incarceration, incidentally discovered cases of Littre's hernia without incarceration are even rarer. A three-month-old boy was referred to our hospital with a three-month history of right inguinal swelling. Although the swelling was reducible, re-prolapse was readily observed. Small bowel obstruction and gastrointestinal bleeding had not been experienced. Laparoscopic herniorrhaphy was planned for right inguinal hernia repair at four months of age during which Littre's hernia was incidentally discovered intraoperatively. Following laparoscopic herniorrhaphy, extracorporeal small bowel resection was performed. The postoperative course was uneventful and the patient was followed up for nine months without symptoms. Laparoscopic herniorrhaphy is a useful surgical technique, as it may facilitate the detection of unexpected complications, which might be overlooked with the inguinal approach.

Novel and simple method using cable ties to induce intestinal strangulation in a rat model

BACKGROUND The pathogenesis of intestinal fibrosis after strangulation in abdominal surgery is not fully understood. Developing an experimental and reliable method is needed to overcome this problem. This study aimed to develop an effective method for intestinal strangulation leading to fibrosis, which might induce intestinal obstruction. METHODS This study was conducted from 2018 to 2019 at the Department of Pharmacology, Faculty of Medicine, Universitas Indonesia. A total of 24 Sprague Dawley rats were used in this study. Artificial intestinal strangulation using cable ties made of durable plastic, which is generally used to ligate objects, was applied, and rats were further classified into control, 6-hour, and 24-hour strangulation groups. At the end of the study, the rats were sacrificed, intestinal tissues were collected, and histomorphological changes were observed using hematoxylin and eosin stain. Moreover, Masson’s trichome staining was used to assess collagen density. RESULTS Median collagen density score of the 24-hour strangulation group was higher than the control. A significant difference in collagen density was found between the submucosal layer of the 24-hour strangulation group and the control (45.4 [11.4] versus 32.4 [14.0], p<0.001) and between the mucosa of the 6- and 24-hour strangulation groups and the control (26.9 [17] versus 6.46 [4.3], p = 0.01 and 24.9 [8] versus 6.46 [4.3], p = 0.004, respectively). CONCLUSIONS The simple use of cable ties adequately promotes intestinal strangulation.

Litrre's hernia: partially reduced inguinal hernia in a 3-year-old boy

This report examines the case of a 3-year-old child presenting with a 1-month history of swelling in the right groin. The boy had no associated nausea or vomiting, was afebrile and had had normal bowel movements. Attempts to reduce the swelling were only partially successful. Ultrasonography indicated the presence of turbid hydrocele and a hernia sac containing an intestinal loop. Accordingly, the patient underwent an urgent herniotomy. Exposing the hernia sac revealed 5 cm Meckel's diverticulum, and the base of the diverticulum was resected from the inside of the hernia sac. The boy was discharged 4 days after the operation in good clinical condition. The presented case highlights the need to consider Littre's hernia when dealing with partially reduced inguinal hernias in children with no general signs or evidence of intestinal obstruction.