Littré’s hernia – a case of a Meckel’s diverticulum in a strangulated femoral hernia and literature review

Resumo

Introduction: Meckel’s diverticulum is the most common gastrointestinal congenital anomaly and it results from an incomplete obliteration of the vitelline duct. Littré’s hernia is defined by the presence of a Meckel’s diverticulum in a hernia sac. A strangulated Meckel’s diverticulum in a femoral hernia is an extremely rare entity and its management requires prompt surgery.

Case Report: We describe a case of a 18-year-old woman that presented with a painful incarcerated femoral hernia in her left groin. She did not have any signs or symptoms of bowel obstruction. During surgery, a Meckel’s diverticulum was identified in the hernia sac. The  small bowel was not herniated and did not show signs of ischaemia, thus, an enterectomy was not required. A diverticulectomy was performed and the hernia defect was subsequently repaired with a modified Lichtenstein technique.

Discussion: The symptomatology of a complicated Meckel’s diverticulum is non-specific and dependent on the type of complication. The diagnosis of Littré’s hernia is challenging and difficult to establish preoperatively since its presentation is ambiguous and imaging has a limited role. When small bowel obstruction is caused by a complicated Meckel’s diverticulum, the main aim of surgery is to remove the diverticulum and to correct the associated pathology, either by laparoscopy or by an open surgical approach.

Conclusion: A patient’s condition and surgeon based management is generally adopted in case of a strangulated Littré’s hernia. Nevertheless, it requires complete resection of the diverticulum to avoid future complications.