Litrre’s hernia: partially reduced inguinal hernia in a 3-year-old boy

This report examines the case of a 3-year-old child presenting with a 1-month history of swelling in the right groin. The boy had no associated nausea or vomiting, was afebrile and had had normal bowel movements. Attempts to reduce the swelling were only partially successful. Ultrasonography indicated the presence of turbid hydrocele and a hernia sac containing an intestinal loop. Accordingly, the patient underwent an urgent herniotomy. Exposing the hernia sac revealed 5 cm Meckel’s diverticulum, and the base of the diverticulum was resected from the inside of the hernia sac. The boy was discharged 4 days after the operation in good clinical condition. The presented case highlights the need to consider Littre’s hernia when dealing with partially reduced inguinal hernias in children with no general signs or evidence of intestinal obstruction.

Uncommon Cause of Intestinal Obstruction: Umbilical Littré’s Hernia

Introduction: Meckel's diverticulum occurs in 0.3-3% of the world population. This is the embryological remnant due to the lack of obliteration of the omphalomesenteric duct at the fifth week of gestation. The complication of Meckel's diverticulum that protrudes through any hernial orifice is called Littré's hernia. In this case, it presents through an umbilical defect. Objective: Report a case of umbilical Hernia Littré given its low incidence. Case Report: A 26-year-old male with no significant history. The physical examination revealed an umbilical defect measuring 1 cm in diameter with no evidence of incarceration or strangulation. Conservative decompressive management was established, nasogastric tube with initial expenditure of 400 milliliters of gastrobiliary content; however, after 12 hours there was no clinical improvement. Surgical management was decided, an exploratory laparotomy was performed, as findings of little free fluid with an inflammatory appearance, 1 cm umbilical defect with a hernial sac containing a Meckel diverticulum. Conclusion: The presentation of these clinical cases enriches the literature and gives us the opportunity to identify more of these rare clinical cases.

Perforated Incisional Littre’s Hernia: A Rare Content of a Common Hernia

Anticipation of complications is of paramount importance for a surgeon. Incisional hernia is a well-known complication for abdominal surgeries. Risk factors such as increasing age, obesity, male gender are well known. Intestinal obstruction, strangulation and perforation are imminent complications of this type of hernia if they become incarcerated. Common contents of a ventral incisional hernia are small bowel, large bowel and omentum. Even though Meckel’s diverticulum is a common gastrointestinal anomaly, it is rarely found to be the content of a hernial sac. A hernia sac containing Meckel’s diverticulum is also known as Littre’s hernia. Only a few cases have been reported in the literature. Thus here we present a case of perforated Meckel’s diverticulum that was entrapped in the ventral incisional hernia.

Two-stage laparoscopic surgery for incarcerated umbilical Littre’s hernia in severely obese patient: a case report

Background Littre's hernia containing Meckel's diverticulum is an extremely rare disease. We report an adult case of two-stage laparoscopic surgery for incarceration of Meckel's diverticulum in an umbilical hernia. Case presentation The case involved a 23-year-old, severely obese man with BMI 36.5 kg/m2. After experiencing effusion from the umbilicus for 2 months, and was referred from a local dermatologist. We diagnosed an infected urachal remnant, and antibiotic therapy was performed first. Surgery was planned for after the infection disappeared. During follow-up, effusion from the umbilicus took on an intestinal fluid-like character, so we diagnosed small intestinal cutaneous fistula and performed surgery. Under laparoscopy, we found a Meckel's diverticulum incarcerated in an umbilical hernia. The diverticulum was resected first, and the incarceration was released. The umbilicus was infected, so we planned repair of the umbilical hernia in a second surgery. The postoperative course was uneventful and the patient was discharged on postoperative day 5. One month after the initial operation, we confirmed that there were no signs of infection, and performed umbilical hernia repair using the laparoscopic intraperitoneal onlay mesh (IPOM) repair. Postoperative progress was uneventful and he was discharged on postoperative day 4. No recurrence or infection was observed until 8 months postoperatively. Conclusions We performed dissection of the diverticulum and umbilical hernia repair for the incarcerated umbilical Littre's hernia under laparoscopy in a severely obese patient. The risk of mesh infection seems to be avoidable using a two-stage surgery, and the risk of recurrence can be reduced using the IPOM repair compared with simple suture closure.

A Rare Case of Acquired Transthoracic Littre's Hernia

Introduction The Littre hernia is a rare complication of Meckel's diverticulum. Meckel's diverticulum is vestigial remnant of the omphalomesenteric duct occurring in approximately 2% of the general population with an estimated 4 to 16% risk of complications. Usual sites of the Littre hernia include inguinal (50%), umbilical (20%), and femoral (20%). We report a case of an acquired transthoracic Littre's hernia occurring through the left part of the diaphragm triggered by a history of traumatic rib fractures associated with alcohol abuse. Case Report A 71-year-old man presented with 4-day history of worsening shortness of breath, colicky lower abdominal pain, and inability to open bowels despite passing flatus, without nausea or vomiting. His past medical history was remarkable for multiple traumatic rib fractures caused by falls which were associated with excessive alcohol consumption. A noncontrast computed tomography (CT) scan of the abdomen and pelvis showed distended jejunal loops containing air/fluid levels likely resulting from herniated jejunum between the left chest wall and left diaphragm. An urgent laparotomy was performed which revealed small bowel and omentum herniating through a small defect in the left posterior hemidiaphragm. The contents of the sac were reduced and a Meckel's diverticulum was found inside the sac, characteristic of Littre's hernia. The diaphragmatic defect was closed and the Meckel diverticulum stapled and excised. Discussion Herniation of Meckel's diverticulum through the diaphragm most commonly occurs in the pediatric population. Acquired transthoracic Littre's hernia is rare and may arise following thoracobdominal trauma caused by surgery, motor vehicle accidents, and falls from height. Left-diaphragmatic tears are characteristically more clinically apparent and symptomatic than the right since the liver often has a protective effect on the right part of the diaphragm. Herniation of abdominal contents in the chest cavity causes respiratory distress and requires urgent surgical correction. Diagnosis is often delayed since diaphragmatic hernia tends to present very late after the initial trauma, subjecting the patient to possible life-threatening complications. While it is easier to reduce the herniated contents and repair the diaphragm via a thoracic approach, laparotomy is often preferred in cases of acute trauma associated with intra-abdominal injuries. Repair of Littre's hernia then consists of resection of the diverticulum and herniorraphy. Conclusion Internal Littre's hernia is usually of congenital origin. This is the first case of a transthoracic Littre's hernia caused by traumatic rib fractures. Hence, it is of utter importance that a clinician is aware of such uncommon pathology.