Expansion
Only the antimesenteric border of the bowel enters the sac
Expansion
In a Richter’s hernia, only part of the circumference of the bowel wall; the antimesenteric border - is caught in the hernial defect. The lumen remains patent.
The consequences are treacherous:
- No obstruction - the patient continues to pass flatus and stool
- Strangulation still occurs - the trapped segment becomes ischaemic and can perforate
- Diagnosis is therefore often late, with presentation as sepsis or a fistula
It occurs most often at defects with a small, rigid ring, the femoral ring classically, and also at laparoscopic port sites, which is why fascial defects of 10 mm or more should be closed.
Contrast it with other eponymous hernias:
- Littre’s - contains a Meckel’s diverticulum
- Amyand’s - contains the appendix
- Maydl’s - a W-shaped loop, with the strangulated segment lying inside the abdomen