A case report of an asymptomatic necrotic Meckel's diverticulum in an inguinal hernia during elective surgery in a resource limited setting: Littre's hernia

A case of spontaneous reduction of incarcerated inguinal hernia caused by Meckel's diverticulum

Inguinal hernias with a Meckel's diverticulum are called Littre hernias and are rare diseases. In many cases, symptoms of incarceration or intestinal obstruction are present, and emergency surgery is generally required. However, imaging diagnosis and clinical symptoms are similar to those of incarceration of inguinal hernias, making preoperative diagnosis difficult. In most cases, diagnosis is made during emergency surgery. A 54-year-old man with abdominal pain was found to have a right-sided incarcerated inguinal hernia on abdominal computed tomography. The incarceration spontaneously reduced, although a Meckel's diverticulum was discovered during emergency laparoscopic surgery for an inguinal hernia. Mesh repair and Meckel diverticulotomy were performed. In cases of inguinal hernias due to a Meckel's diverticulum, it is difficult to diagnose a Meckel's diverticulum as the cause without exploring the intestine, although laparoscopic hernia repair is useful to investigate this possibility.

Littre's hernia in children

Meckel's diverticulum is a common congenital anomaly of the gastrointestinal (GI) system, which remains asymptomatic unless some complications occur. Littre's hernia is a rare complication of Meckel's diverticulum, where it herniates into the hernial sac. It is difficult to diagnose this condition preoperatively. Strangulation and incarceration are common, which may lead to necrosis and perforation of Meckel's diverticulum. In this report, we describe the successful management of a boy in his early childhood presenting with an irreducible and strangulated right inguinal hernia, which turned out to be Littre's hernia on exploration. Additionally, we conducted a literature review using Google Scholar and PubMed to identify publications on Littre's hernia in paediatric patients.

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.

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

INTRODUCTION

Littre's hernia (LH) is due to the presence of a Meckel's diverticulum (MD) in a hernial sac. It is an extremely rare condition in less than 1 % of all MD cases. It is often asymptomatic and is diagnosed incidentally during routine surgery for hernia repair. Surgery is the main treatment. Although the management of uncomplicated MD remains controversial, MD's management in the setting of either bowel obstruction or of Littre's hernia is done according to the clinical principles combined with the availability of local expertise.

PRESENTATION OF CASE

We report a case of an 11-year-old boy presented to the emergency room with a diagnosis of acute obstructive syndrome. Radiological exams were inconclusive. Intra-operatively findings showed a strangulated MD trapped in a small umbilical hernia. A simple wedge resection, followed by a primary closure of the remaining defect was performed. During 12 months of observation the patient remains in good condition.

DISCUSSION

LH is an uncommon type of abdominal wall hernia. Preoperative diagnosis is difficult. Even abdominal ultrasound and computed tomography (CT) cannot reveal the right diagnosis and it is generally performed intraoperatively. The main treatment is surgery. Repair of a Littre hernia requires both management of Meckel's diverticulum and repair of the hernia with sutures or mesh.

CONCLUSION

LH is a very rare type of hernia. Diagnosis is very difficult. All surgeons should be aware of this type of hernia to avoid life-threatening complications. The application of hernia repair recommendations for children may anticipate the happening of complicated LH.

An unusual form of incisional hernia: A case report of Littre's hernia

INTRODUCTION

Littre's hernia (LH) is a rare condition involving Meckel's diverticulum within a hernia sac, with an incidence of <0.1 % of all complicated hernias. To this day, only a few case reports have been published concerning this entity.

CASE PRESENTATION

A 48-year-old patient with a history of four midline C sections and an incarcerated incisional midline hernia was admitted to the emergency department for small bowel obstruction evolving for 12 h. Examination revealed an incarcerated midline incisional hernia. An abdominal CT scan was performed, showing a multi-orifice incisional hernia with a small bowel loop and a 3 cm abscess. The patient underwent an urgent midline laparotomy. During surgery, we found a small bowel loop with a perforated Meckel's diverticulum, located 50 cm from the ileocaecal valve, associated with a 3 cm abscess. Surgical drainage of the abscess, resection of 20 cm of small bowel, including the diverticulum, and an appendicectomy were performed. The incisional midline hernia was managed by herniorrhaphy. The post-operative course was uneventful.

CLINICAL DISCUSSION

Surgeons need to keep in mind the possibility of discovering Meckel's diverticulum in a hernia sac in every incarcerated hernia. Complete history intake and careful physical examination are important to uncover signs prompting clinical suspicion. Littre's hernia is rare and difficult to diagnose, with no distinguishing clinical features or physical signs.

CONCLUSION

Managing LH involves treating the symptomatic Meckel's diverticulum with various resection methods and the hernia itself, with mesh application being a controversial topic. Prophylactic resection remains debatable among experts.