Baig Sarfaraz Jalil, Priya Pallawi
Department of Minimal Access Surgery and Surgical Gastroenterology, Belle Vue Clinic, Kolkata, West Bengal, India.
J Minim Access Surg. 2022 Apr-Jun;18(2):308-310. doi: 10.4103/jmas.JMAS_99_21.
Abdominal wall Richter's hernia is rare. The usual presentation is with irreducibility, obstruction and strangulation. Occasionally, enterocutaneous fistula containing small bowel has been reported. Management is frequently difficult due to emergency presentation and contamination. A 60-year-old male with a history of suture repair of umbilical hernia presented with faecal discharge from a long-standing recurrent hernia in the background of obesity and history of pulmonary embolism. There were no features of peritonitis or obstruction. After optimisation, we took the patient for a diagnostic laparoscopy with curative intent. Diagnostic laparoscopy revealed a Richter's hernia containing transverse colon. The patient was treated with resection of the involved colonic segment, anastomosis, complete excision of the fistula tract along with surrounding skin, negative pressure wound therapy and delayed skin closure. To our knowledge, this is the first report of a spontaneous umbilical Richter's hernia complicated with a colocutaneous fistula. Management was challenging due to emergency presentation, multiple comorbidities as well as faecal contamination. Minimal access approach may have helped by decreasing the contamination and surgical site infection in the postoperative period.
腹壁里氏疝罕见。其常见表现为不可复性、梗阻和绞窄。偶尔，有报道称出现含小肠的肠皮肤瘘。由于急诊情况和污染，治疗往往困难。一名60岁男性，有脐疝缝合修复史，因肥胖及肺栓塞病史，长期复发性疝出现粪便排出。无腹膜炎或梗阻表现。优化处理后，我们以治愈为目的对患者进行诊断性腹腔镜检查。诊断性腹腔镜检查发现一个含横结肠的里氏疝。患者接受了受累结肠段切除、吻合、瘘管连同周围皮肤完整切除、负压伤口治疗及延迟皮肤缝合。据我们所知，这是首例自发性脐部里氏疝合并结肠皮肤瘘的报道。由于急诊情况、多种合并症以及粪便污染，治疗具有挑战性。微创入路可能通过减少术后污染和手术部位感染而有所帮助。
