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Richter's Inguinal Hernia

Richter Inguinal Hernia


Presentation

  • BACKGROUND: The deceptive entity of Richter's hernia typically presents with complications that are usually associated with high morbidity and mortality.[ncbi.nlm.nih.gov]
  • Abstract Rarely inguinal hernia may present with rare complication of spontaneous faecal fistula.[omicsonline.org]
  • As such, the bowel may not be obstructed, even if the hernia is incarcerated or strangulated, and the patient may not present with vomiting. c.[gradestack.com]
  • A case of Richter’s hernia presenting after a previous inguinal herniorrhaphy Sharadendu Bali, Maneshwar Singh Utaal, Navdeep Garg.[scopemed.org]
Chills
  • An 81-year-old man presented to the emergency department complaining of acute onset abdominal pain, vomiting for one day, and subjective fever and chills. The patient had had non-bloody bowel movements, and was able to pass flatus.[journals.lww.com]
  • The patient denied fever or chills. Past medical history is significant for diabetes mellitus type 2, hypertension, hypothyroidism, recurrent urinary tract infections, and chronic atrial fibrillation. She had no history of abdominal surgery.[ncbi.nlm.nih.gov]
Inguinal Pain
  • Case 2 A 29-year-old male presented with a week history of a right inguinal pain. The patient was ill-looking with a body temperature 38.9 C, heart rate 102 bpm, and blood pressure 99/52 mmHg.[ijcasereportsandimages.com]
Falling
  • Few patients fall into this category. Most external hernias can be successfully repaired surgically under regional or local infiltration anaesthesia with minimal morbidity.[surgwiki.com]
Pediatric Disorder
  • disorders, including neoplasms, vascular anomalies, and childhood interstitial lung diseases (ChILD)[books.google.es]
Multiple Organ Dysfunction Syndrome
  • Organ Dysfunction Syndrome 321 Anesthesia 341 Perioperative Management 363 Section Two Gastrointestinal and Abdominal Disease 397 Haile T Debas MD 399 Peritoneum and Acute Abdomen 413 General Principles of Minimally Invasive Surgery 429 Esophagus 455[books.google.de]
Abdominal Pain
  • A 71 year -old man with no history of abdominal surgery admitted for preshock, abdominal pain, and vomiting evidenced slight tenderness in the upper abdomen but neither muscular defense nor the sign of Blumberg.[jstage.jst.go.jp]
  • This is a case report of a 69-year-old male with a history of herniorrhaphy for left inguinal hernia 22 years back presenting with swelling in left groin region for 4 days with sudden onset of left-sided acute abdominal pain and vomiting for 1 day.[scopemed.org]
  • An 81-year-old man presented to the emergency department complaining of acute onset abdominal pain, vomiting for one day, and subjective fever and chills. The patient had had non-bloody bowel movements, and was able to pass flatus.[journals.lww.com]
  • We report a 31 years old patient from the Sultan Qaboos University Hospital who presented with colicky lower abdominal pain associated with a tender swelling above and lateral to the inguinal canal.[jpma.org.pk]
Abdominal Distension
  • Physical examination was significant for abdominal distension, abdominal tenderness, guarding over the right lower quadrant and inguinal region, and hyperactive bowel sounds.[journals.lww.com]
  • The patient presents with symptoms and signs of intestinal obstruction (abdominal colic, vomiting, constipation, abdominal distension) (see Small bowel obstruction ), together with a tender irreducible hernia.[surgwiki.com]
Hyperactive Bowel Sounds
  • Physical examination was significant for abdominal distension, abdominal tenderness, guarding over the right lower quadrant and inguinal region, and hyperactive bowel sounds.[journals.lww.com]
Vascular Disease
  • Inhalt Minimally Invasive Approaches to Vascular Disease 1135 1137 Section Five Cardiothoracic Surgery 1163 Lung Neoplasms 1189 Lung Infections and Trauma 1217 VideoAssisted Thoracic Surgery 1231 Pericardium 1265 Mediastinum 1281 Congenital Heart Disease[books.google.de]
Heart Disease
  • Inhalt Minimally Invasive Approaches to Vascular Disease 1135 1137 Section Five Cardiothoracic Surgery 1163 Lung Neoplasms 1189 Lung Infections and Trauma 1217 VideoAssisted Thoracic Surgery 1231 Pericardium 1265 Mediastinum 1281 Congenital Heart Disease[books.google.de]
Testicular Pain
  • Ischaemia produces testicular pain, tenderness and swelling. Testicular atrophy is observed in 1–5% of males.[surgwiki.com]
Neglect
  • METHODS: A case report of the management of an elderly patient who presented with Fournier's gangrene to a Nigerian tertiary institution following a neglected Richter's hernia on the right groin.[ncbi.nlm.nih.gov]
  • […] a. inguinal hernia b. saphena varix c. femoral hernia d. femoral artery aneurysm e. groin lymphadenopathy f. undescened testis g. hydrocele h. psoas abscess h: psoas abscess may develop as the sequel to any retroperitoneal infection, or even a neglected[quizlet.com]
Hyperactivity
  • Physical examination was significant for abdominal distension, abdominal tenderness, guarding over the right lower quadrant and inguinal region, and hyperactive bowel sounds.[journals.lww.com]

Treatment

  • Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances.[books.google.de]
  • A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. ‎[books.google.de]
  • The treatment is always surgical with high chance of a resection and anastomosis of the involved segment of the bowel.[gradestack.com]
  • He is Editor in Chief of Digestive & Liver Disease, International Editor of the Scandinavian Journal of Gastroenterolog, and Associate Editor of Current Treatment Options in Gastroenterolgy.[books.google.de]
  • The danger group is where symptoms are vague and delay identification and treatment, which increases mortality. The post-necrotic group is where perforation leads to formation of a fistula.[journals.lww.com]

Prognosis

  • Treatment and prognosis Surgical management is often necessary 2 . Complications Venous circulation of the incarcerated hernia is impaired, which can result in bowel infarction and gangrene.[radiopaedia.org]
  • Note that Richter's hernia is associated with a significantly high mortality rate of 17% to 21%; the prognosis is particularly unfavorable if peritonitis develops. Take home messages 1.[prognosisapp.com]
  • Prognosis After successful hernia repair, there is always the potential for recurrence. Modifiable patient risk factors for recurrence include elevated BMI, smoking, diabetes and steroid use.[statpearls.com]

Etiology

  • Each chapter presents anatomy, physiology and associated scientific development, disease etiology and prevention, appropriate diagnostic procedures, treatment of benign and malignant disease, and well illustrated, technical discussion of how-to-do surgery[books.google.de]
  • Etiology: hernia sac containing a Meckel’s diverticulum. First described by Littre in 1700. Richter described parietal hernia 1778. Bibliography A. Littre: Observations sur une nouvelle espèce de hernie.[whonamedit.com]
  • Richter’s Hernia; its etiology, recognition, and managrment. AMA Arch Surg 1956;73(4):590–4. Habib Faridi S, Siddiqui B, Amanullah Khan M, Anees A, Ali SA.[jamc.ayubmed.edu.pk]
  • Etiology: • Direct: weakness of the posterior floor of the inguinal canal (acquired). • Indirect: patent processus vaginalis (Congenital) . 25.[de.slideshare.net]
  • Etiology: • Direct: weakness of the posterior floor of the inguinal canal (acquired). • Indirect: patent processus vaginalis (Congenital). 25.[slideshare.net]

Epidemiology

  • Epidemiology Epidemiological data refers to the US, unless otherwise specified. Etiology In contrast to indirect inguinal hernias, which may occur congenitally, femoral hernias are almost always acquired.[amboss.com]
  • Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology[brainscape.com]
  • Epidemiology Richter hernias typically occur in elderly patients between 60-80 years old; however, they can theoretically manifest at any age, and pediatric case reports exist. There is a slightly increased incidence in the female population.[statpearls.com]
  • Inguinal hernia  Epidemiology:  Male : Female • by 9 to 1 ratio  young adults mostly have indirect inguinal hernia.  As age of patient increases, the incidence of direct hernias increases . 18.[de.slideshare.net]
  • Inguinal hernia  Epidemiology:  Male : Female • by 9 to 1 ratio  young adults mostly have indirect inguinal hernia.  As age of patient increases, the incidence of direct hernias increases. 18.[slideshare.net]
Sex distribution
Age distribution

Pathophysiology

  • References: [3] Pathophysiology Boundaries of the femoral canal Typical femoral hernia : (common): protrusion of intraperitoneal contents along with the transverse abdominal fascia through the femoral ring into the femoral canal Atypical femoral hernias[amboss.com]
  • However, these many factors are variable and inadequate for managing and understaning the complex pathophysiology of inguinal hernias.[inguinalhernias.weebly.com]
  • Pathophysiology: Causes associated with all groin hernias: erect human posture, muscle deficits, and connective tissue changes (secondary to smoking, age, or systemic changes).[medschool.lsuhsc.edu]
  • Pathophysiology A Richter hernia, by definition, is a herniation of only a portion of the circumference of the bowel wall through the fascial defect. Most commonly it is the anti-mesenteric portion of the bowel.[statpearls.com]
  • The pathophysiology of appendicitis in the setting of this strangulated de Garengeot's hernia might involve luminal obstruction caused by the rigid femoral neck or by the presence of the Richter's hernia.[ncbi.nlm.nih.gov]

Prevention

  • How to use an article about therapy or prevention: A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA 1993:270:2598-2601. 33. Guyatt GH, Sackett DL, Cook DJ. Users' guides to the medical literature. ‎[books.google.de]
  • The lumen of the hernia remains free of preventing obstruction. With no intestinal obstruction between onset, symptoms, and identification, there is more time for bowel necrosis to set in and progress.[journals.lww.com]
  • Even when all the proper steps are taken to prevent infection, infections still can occur. The treatment for wound infection is often opening up the incision site to allow for drainage and antibiotics.[livestrong.com]
  • […] site of hernia Symptoms of bowel obstruction Nausea and vomiting Symptoms of bowel ischemia Toxic Imaging Findings Differential Diagnosis Soft tissue tumors Lymphadenopathy Treatment Surgery for incarceration Inguinal hernias are usually repaired to prevent[learningradiology.com]
  • A truss cannot prevent herniation through the femoral ring and has no place in the management of femoral hernia. Surgery involves opening and emptying the sac, and performing a herniorrhaphy to prevent recurrence.[surgwiki.com]

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