Smart N, Immanuel A, Mercer-Jones M
Department of Surgery, North Devon District Hospital, Raleigh Park, Barnstaple, Devon, EX31 7QW, UK.
Hernia. 2007 Aug;11(4):373-6. doi: 10.1007/s10029-007-0197-4. Epub 2007 Feb 9.
Littre's hernia was originally defined as "the presence of a Meckel's diverticulum in any hernia sac" by Rieke in 1841. It is a rare finding at any age, and its true incidence is unknown. The conventional treatment for Littre's hernia is wedge resection of the diverticulum and repair of the hernia from within the sac. However, the advent of laparoscopic surgery has altered the management of all abdominal hernias, including Littre's hernia.
We present a case of a 55-year-old woman who presented as an emergency with right iliac fossa pain and tenderness. A CT scan demonstrated a 46 x 25 x 25 mm lesion related to the distal ileum extending towards the inguinal canal. At laparoscopy she was found to have a Meckel's diverticulum herniating through the deep inguinal ring into the right inguinal canal. We report the laparoscopic excision of the Meckel's diverticulum using an endoscopic stapling device and repair of this hernia with Permacol, an acellular porcine collagen mesh. The patient made a quick recovery and was discharged 5 days post-operatively. A complication of an umbilical port site infection was treated 2 weeks post-operatively with oral antibiotics. To date there has been no recurrence of the hernia and no right inguinal pain. Laparoscopic repair of Littre's hernia using Permacol has not been reported previously.
Laparoscopy is a safe, inexpensive and efficient method for the diagnosis and treatment of Littre's hernia. Permacol is a strong yet supple material for hernia repair.
1841年里克将里脱疝最初定义为“任何疝囊内存在梅克尔憩室”。它在任何年龄都是罕见发现，其真实发病率未知。里脱疝的传统治疗方法是憩室楔形切除术并从囊内修补疝。然而，腹腔镜手术的出现改变了包括里脱疝在内的所有腹部疝的治疗方式。
我们报告一例55岁女性患者，因右下腹疼痛和压痛急诊入院。CT扫描显示一个46×25×25毫米的病变，与回肠末端有关，延伸至腹股沟管。腹腔镜检查发现她有一个梅克尔憩室通过腹股沟深环疝入右腹股沟管。我们报告了使用内镜吻合器切除梅克尔憩室，并使用脱细胞猪胶原网Permacol修补该疝。患者恢复迅速，术后5天出院。术后2周，脐部穿刺部位感染并发症经口服抗生素治疗。迄今为止，疝未复发，右腹股沟无疼痛。此前尚未报道过使用Permacol进行腹腔镜下里脱疝修补术。
腹腔镜检查是诊断和治疗里脱疝的一种安全、廉价且有效的方法。Permacol是一种用于疝修补的坚韧而柔软的材料。
