An unusual form of incisional hernia: A case report of Littre's hernia

Abstract

Introduction: Littre's hernia (LH) is a rare condition involving Meckel's diverticulum within a hernia sac, with an incidence of <0.1 % of all complicated hernias. To this day, only a few case reports have been published concerning this entity.

Case presentation: A 48-year-old patient with a history of four midline C sections and an incarcerated incisional midline hernia was admitted to the emergency department for small bowel obstruction evolving for 12 h. Examination revealed an incarcerated midline incisional hernia. An abdominal CT scan was performed, showing a multi-orifice incisional hernia with a small bowel loop and a 3 cm abscess. The patient underwent an urgent midline laparotomy. During surgery, we found a small bowel loop with a perforated Meckel's diverticulum, located 50 cm from the ileocaecal valve, associated with a 3 cm abscess. Surgical drainage of the abscess, resection of 20 cm of small bowel, including the diverticulum, and an appendicectomy were performed. The incisional midline hernia was managed by herniorrhaphy. The post-operative course was uneventful.

Clinical discussion: Surgeons need to keep in mind the possibility of discovering Meckel's diverticulum in a hernia sac in every incarcerated hernia. Complete history intake and careful physical examination are important to uncover signs prompting clinical suspicion. Littre's hernia is rare and difficult to diagnose, with no distinguishing clinical features or physical signs.

Conclusion: Managing LH involves treating the symptomatic Meckel's diverticulum with various resection methods and the hernia itself, with mesh application being a controversial topic. Prophylactic resection remains debatable among experts.

Keywords: Emergency surgery; Incisional hernia; Littre's hernia; Meckel's diverticulum.

Fig. 1

Preoperative CT scan. (a) and (b) axial views of an arterial phase CT scan images showing the incisional hernia containing a small bowel loop and a 3-centimeter abscess.

Fig. 2

Intraoperative images. (a), (b) and (c) showing the congestive ileal loop found in the hernia sac with a perforated Meckel's diverticulum (White arrows). The proximal loop is pointed at with the dissecting forceps in (b). The lumen of the perforated diverticulum is shown in (c).