An unusual cause of small bowel obstruction caused by a Richter's-type hernia into the urinary bladder.

The authors present an unusual case of small bowel obstruction in a 62-year-old man. A 62-year-old man with a background of transitional cell carcinoma (TCC) of the bladder presented to the emergency department with abdominal pain, distension, vomiting and had not opened his bowels for three days. 3 weeks previously he had a repeat Transurtheral resection of bladder tumour (TURBT), during which there was an iatrogenic perforation of the bladder. A CT scan of the abdomen and pelvis revealed small bowel obstruction but did not identify a cause. At laparotomy the cause of the obstruction was identified as a section of the small bowel that had partially herniated into the bladder, via the perforation. The defect was repaired and the patient made an uneventful recovery. Herniation of the bowel into a defect in the bladder wall is a rare event with only 6 previous cases reported in the literature. It can cause signs and symptoms of bowel obstruction. In patients with known bladder perforations who present with symptoms and signs of bowel obstruction, bowel herniation into the bladder should be considered. Early surgical intervention may be necessary if the patient is clinically unwell with appropriate symptoms and signs and imaging does not provide conclusive answer.

Sakai NS ，Acharya V ，Mansour S ，Saleemi MA ，Cheslyn-Curtis S ... -  《International Journal of Surgery Case Reports》

Richter's Type Recurrent Indirect Inguinal Hernia, an Extremely Rare Occurrence: A Case Report.

Richter's type recurrent indirect inguinal hernia remains to be an extremely rare entity reported scarcely. It may present with grave complications in the absence of symptoms and signs of intestinal obstruction. The aim of this study is to report a rare case of Richter's hernia after a previously repaired indirect inguinal hernia. A 31-year-old male farmer came up with complaints of colicky abdominal pain and two episodes of vomiting. He had a previous right inguinal surgery. A physical examination revealed a full abdomen with right inguinal tenderness and oblique surgical scar. Abdominal ultrasound showed a bowel segment entrapped in the deep inguinal ring of the inguinal canal. Right inguinal exploration was done, and the finding was a gangrenous Richter's type recurrent indirect inguinal hernia. The patient was discharged and improved on the seventh post-operative day after resection and anastomosis. Richter's hernia is a rare form of hernia that occurs when the anti-mesenteric border of the bowel is partly trapped in a tight hernial ring. Its rarity, combined with the fact that it may present in the absence of typical symptoms and signs of intestinal obstruction and local physical findings, poses a diagnostic challenge which often end up with complications like gangrenous bowel at the time of diagnosis. Richter's hernia can occur in an extremely rare form as Richter's type recurrent indirect inguinal hernia. A high degree of suspicion, an early referral and timely imaging on the provider's side may prevent mortality and morbidity.

Bayeh A ，Limenh S 《-》

Small bowel obstruction due to internal herniation through a right side diaphragmatic defect; an unusual case report.

Nazari FA 《International Journal of Surgery Case Reports》

Laparoscopic port site Richter's hernia - An important lesson learnt.

Rammohan A ，Naidu RM 《International Journal of Surgery Case Reports》

Small-bowel intestinal obstruction caused by an unusual internal hernia.

Li JC ，Chu DW ，Lee DW ，Chan AC ... -  《Asian Journal of Surgery》