Richter's hernia is a rare form of hernia when an antimesenteric part only of the circumference of the small bowel is strangulated in a hernial sac. This kind of hernia is reported for the narrowest openings in the abdominal wall: umbilical, femoral, and obturator.
Mechanisms of the Richter's to develop were suggested as early as in the 18th century.
The first hypothesis was coined by A. Littre, 1701, that that sort of herniation may occur if adhesions between an intestinal loop and hernial sac have developed before the hernia formation. There are no adhesions found in the majority of cases, though.
The second mechanism was suggested by A. Richter, 1778, that the hernia develops due to the so-called 'elastic constriction' by a narrow opening after coughing, etc.
However, all these openings (umbilical, femoral, and obturator) are not elastic absolutely, so that this mechanism seems to be almost improbable.
Is there any news on the matter since the 18th century?
I do not have any news on the matter of its causation. As you mentioned it is seen with narrow necks and now we are seeing it in port site hernias
I have written already that the matter is more complex than it is commonly believed. Will you see the link below, please?
https://www.researchgate.net/post/Clinical_differentiation_of_direct_and_indirect_inguinal_hernias_is_it_worthwhile
Just sharing recent encounter with a patient with small bowel obstruction, 3 weeks after laparoscopic assisted vaginal hysterectomy. The cause was a Richter's type hernia through 10mm port site at right iliac fossa. No hernial sac of course. Small bowel adhered to the port site, with partial circumference herniated through causing obstruction.
Dr.Cheah Sin Dee,
Thank you for the case reported. So, that was the Littre mechanism of herniation, was it?
Hi Prof Andrey Borodach,
I thought Littre's hernia refers to those containing a Meckel's diverticulum?
So it is. However, I meant the mechanism of the 'partial' hernia development suggested by Littre (Will you see the short explanation to the question above?)
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