Richter's Hernia as a Cause of Acute Abdomen: An Unusual Case

Abstract

Richter's hernia is a rare entity, accounting for approximately 10–15% of strangulated hernias. It is characterized by the incarceration of only the antimesenteric portion of the small intestine through a narrow defect in the abdominal wall. Unlike other hernias, it usually does not cause complete intestinal obstruction, which makes early diagnosis difficult and may delay treatment. In up to 60% of cases, it can rapidly progress to ischemia and intestinal perforation if not managed promptly, with reported mortality rates of up to 17%.

Although it can occur in various anatomical locations, it is most commonly found in the femoral canal (up to 88% of cases), followed by the inguinal region (12–24%) and the umbilical region, which accounts for approximately 6–10% of cases. It can also appear in incisional or port sites following laparoscopic procedures. Clinical diagnosis is challenging due to the atypical presentation; however, high-resolution ultrasound is useful for identifying the hernia defect and assessing bowel viability, while computed tomography offers higher diagnostic sensitivity in ambiguous cases.

Treatment is surgical and should be performed urgently. When there is irreversible ischemia of the bowel segment, resection and primary anastomosis are required. In contaminated settings, the use of prosthetic mesh is contraindicated. Prognosis is directly related to the time from symptom onset to surgical intervention.

In conclusion, although uncommon, Richter’s hernia should be considered in the differential diagnosis of localized acute abdomen without signs of complete obstruction. Early recognition through imaging and timely surgical management are key to avoiding serious complications and improving patient outcomes.