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

  • Joana S. Moura Médico Interno – Hospital Pêro da Covilhã, Centro Hospitalar Universitário Cova da Beira EPE, Covilhã, Portugal
  • André Vinha Médico Interno – Hospital Pêro da Covilhã, Centro Hospitalar Universitário Cova da Beira EPE, Covilhã, Portugal
  • Sofia Jardim Neves Médico Interno – Hospital Pêro da Covilhã, Centro Hospitalar Universitário Cova da Beira EPE, Covilhã, Portugal
  • Hugo Gameiro Médico Assistente – Unidade Local de Saúde Litoral Alentejano, Santiago do Cacém, Portugal
  • Manuel Pinto Ferreira Médico Interno – Hospital Pêro da Covilhã, Centro Hospitalar Universitário Cova da Beira EPE, Covilhã, Portugal

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.




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Referências

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Publicado
2019-12-28
Como Citar
MOURA, Joana S. et al. Littré’s hernia – a case of a Meckel’s diverticulum in a strangulated femoral hernia and literature review. Revista Portuguesa de Cirurgia, [S.l.], n. 45, p. 17-23, dec. 2019. ISSN 2183-1165. Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/675>. Acesso em: 06 aug. 2020.
Secção
Caso Clínico