Ann Ital Chir. 2021 Sep 2;92:S2239253X21036380.
Describe a rare case of Richter's hernia with caecum incarceration into a right femoral hernia and provide a narrative literature review about its surgical management.
A 46-year-old woman presented to the Emergency Department and to our surgical unit with a two-days history of worsening abdominal pain in the right lower quadrant without nausea or vomiting, associated with an irreducible lump. Computed tomography of the abdomen described a right inguinal hernia containing small bowel with perivisceral fluid in it without signs of small bowel occlusion nor perforation.
A Richter 's femoral hernia with necrotic caecum wall was found but the appendix was not involved. Through a mini-laparotomy, tangential caecal resection and appendectomy were performed. The femoral defect was repaired with a polypropylene mesh-plug placed in the pre-peritoneal space. Postoperative period was uneventful and the patient was discharged on the fifth post-operative day.
Femoral hernias account for only 2-4% of all groin hernias and occur through a small fascial defect in the femoral canal. Due to its narrowness, it leads to a high risk of incarceration and strangulation thus explaining the increased mortality in the emergency setting (up to 10 fold compared with the elective repair). In some cases, symptoms are no specific and uncommon findings have been reported. Surgical exploration is mandatory in the presence of signs of bowel strangulation or perforation and different approaches (either open or laparoscopically) have been described in literature.
Caecum wall necrosis secondary to an incarcerated Richter's femoral hernia is a rare but dangerous event. Surgical approach is selected on surgeon's expertise. The use of prosthetic mesh is always recommended.
Bowel necrosis, Emergency surgery, Hernia repair, Richter's hernia.
描述一例罕见的 Richter 疝病例，即盲肠嵌顿入右侧股疝，并对其手术治疗进行文献回顾。
一名 46 岁女性因右下腹痛加剧两天就诊于急诊科和我们的外科病房，无恶心或呕吐，伴有不可复位的肿块。腹部计算机断层扫描描述了一个右侧腹股沟疝，包含小肠，周围有液体，但没有小肠闭塞或穿孔的迹象。
发现了 Richter 股疝伴坏死盲肠壁，但阑尾未受累。通过小切口腹腔镜手术，进行了斜行盲肠切除术和阑尾切除术。股疝缺损用置于腹膜前间隙的聚丙烯网塞修补。术后恢复顺利，患者在术后第 5 天出院。
股疝仅占所有腹股沟疝的 2-4%，发生在股管内的一个小筋膜缺损处。由于其狭窄，导致嵌顿和绞窄的风险很高，因此在急诊情况下死亡率增加（与择期修复相比增加了 10 倍）。在某些情况下，症状不典型，罕见的报道已经出现。在存在肠绞窄或穿孔迹象时，必须进行手术探查，文献中已经描述了不同的方法（开放或腹腔镜）。
嵌顿性 Richter 股疝导致的盲肠壁坏死是一种罕见但危险的事件。手术方法取决于外科医生的专业知识。建议始终使用假体网片。
肠坏死、急诊手术、疝修补、Richter 疝。
