Jeannot BM, Biraali MA, Mugenyi M, Wetemwami RM, Muhumuza J, Sikakulya FK. Iatrogenic enterocutaneous fistula following an incarcerated Richter's femoral hernia misdiagnosed for an inguinal abscess: A case report.
Int J Surg Case Rep 2024;
119:109736. [PMID:
38704969 PMCID:
PMC11087958 DOI:
10.1016/j.ijscr.2024.109736]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE
As the Richter's hernia contains anti-mesenteric intestinal wall, patients usually do not present with obstructive symptoms. Consequently, this leads to delays in diagnosis and increased morbidity and mortality. Early detection and surgical treatment are therefore paramount to improving outcomes.
CASE PRESENTATION
A 51-year-old female presented with an incarcerated Richter's femoral hernia misdiagnosed as inguinal abscess that underwent incision and drainage. This developed into an enterocutaneous fistula (EC Fistula) and was eventually complicated by peritonitis, requiring laparotomy and herniorrhaphy. Post-operative recovery was uneventful.
CLINICAL DISCUSSION
In advanced stages, Richter's femoral hernia may present with obstructive symptoms as in other incarcerated hernias. Richter's hernias may eventually present with obstructive symptoms in their advanced stages. Their relatively asymptomatic nature increases the risk of complications, such as enterocutaneous fistula.
CONCLUSION
This case highlights how an incarcerated Richter's femoral hernia in a female misdiagnosed as an abscess delayed treatment, increased patient morbidity with development of an enterocutaneous fistula and peritonitis, and mandated surgical exploration to control sepsis and repair the hernia.
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