Department of General and Emergency Surgery, Santa Cruz Hospital, Curitiba, Paraná, Brazil.
Paraná's Kidney Institute, Curitiba, Paraná, Brazil.
Perit Dial Int. 2023 Jul;43(4):339-341. doi: 10.1177/08968608221149555. Epub 2023 Jan 12.
Richter's hernia is a rare type of hernia that occurs when the antimesenteric intestinal wall protrudes through a defect in the abdominal fascia leading to ischaemia, gangrene, bowel perforation and enterocutaneous fistulae. In this article, we describe a rare case of enterocutaneous fistula due to a Richter's hernia after a Tenckhoff catheter removal. This type of complication has not been previously reported in the literature. An 82-year-old man presented with a 1-day history of enteric content at the Tenckhoff catheter insertion site. Seven weeks earlier, the catheter was removed due to peritonitis. Removal was performed using open technique, and the fascia was not closed. Computed tomography revealed a small incarcerated hernia and subcutaneous fluid collection at the previous catheter insertion site. He underwent laparoscopy, which showed a Richter's hernia with perforation of the ileum causing an enterocutaneous fistula. A laparoscopic enterectomy was performed using a primary mechanical anastomosis. The hernia was repaired by primary suture without a mesh because of wound enteral contamination and the small size of the hernia. Richter's hernia has a misleading clinical presentation and contributes to high rates of morbidity and mortality. A secure myofascial closure during catheter removal may reduce the chances of this complication.
里希特疝是一种罕见的疝，发生在肠系膜肠壁通过导致缺血、坏疽、肠穿孔和肠皮肤瘘的腹筋膜缺陷突出时。本文描述了一例经特科霍夫导管移除后因里希特疝引起的肠皮肤瘘的罕见病例。这种并发症以前在文献中没有报道过。一名 82 岁男性因特科霍夫导管插入部位出现肠内容物 1 天就诊。7 周前，因腹膜炎而拔除导管。采用开放技术进行了拔除，筋膜未闭合。计算机断层扫描显示先前导管插入部位有小的嵌顿疝和皮下积液。他接受了腹腔镜检查，显示回肠穿孔引起肠皮肤瘘的里希特疝。采用原发性机械吻合术进行腹腔镜肠切除术。由于伤口肠内污染和疝的小尺寸，采用原发性缝合而未使用网片修复疝。里希特疝的临床表现具有误导性，导致发病率和死亡率高。在导管移除过程中进行安全的筋膜闭合可能会降低这种并发症的发生几率。
