Littre hernia in childhood: a case report with a brief review of the literature

A strangulated umbilical hernia with perforated Meckel diverticulum: Case report

INTRODUCTION AND IMPORTANCE

Meckel's diverticulum (MD) is one of the most common gastrointestinal anomalies and affects 2-3 % of the population. Strangulated umbilical hernia with a perforated Meckel diverticulum is an extremely rare event.

CASE PRESENTATION

We reported here a case of one year old boy of a strangulated umbilical hernia with perforated MD that operated at the Mogadishu hospital. A wedge resection of the MD and anastomosis was performed.

CLINICAL DISCUSSION

MD is one of the most common gastrointestinal anomalies and affects 2-3 % of the population. About 60 % of cases come to medical attention before the age of ten, with the remainder of patients presenting in adolescence and adulthood. It is more difficult to diagnose in males, especially in adulthood.

CONCLUSION

Being aware of the likelihood that there could be a perforated Meckel's diverticulum in a sac of strangulated umbilical hernia has notable importance and may lead to innovative treatment and postoperative rehabilitation modalities.

A case report of an asymptomatic necrotic Meckel's diverticulum in an inguinal hernia during elective surgery in a resource limited setting: Littre's hernia

INTRODUCTION AND IMPORTANCE

Although the common complications of Meckel's diverticulum (MD) are well known, that these congenital intestinal outpouchings may become involved as the content of abdominal hernia sacs is not well appreciated. MD is the most prevalent congenital abnormality of the gastrointestinal tract, but involvement in a hernia, known as Littre's hernia (LH), accounts for less than 1 % of MD cases. Incarcerated LH has been reported sporadically in the literature, with MD found in the sacs of paraumbilical, femoral, inguinal, and incisional hernias.

PRESENTATION OF CASE

We report a LH in a 3-year-old male child who was scheduled for elective herniotomy for a reducible left inguinal hernia. Intraoperatively we found the hernia sac contained a necrotic and perforated MD with viable associated bowel loop. The patient was successfully managed by diverticulectomy and primary repair through a trans-inguinal incision and herniotomy was performed.

CLINICAL DISCUSSION

LH is a rare presentation of MD, and preoperative diagnosis of LH is challenging. Even in the case of a strangulated MD, a patient may not present with the typical signs and symptoms associated with compromised viscous. Once identified, repair of Littre hernia consists of resection of the diverticulum, or segmental bowel resection if necessary, and herniotomy.

CONCLUSION

The finding of a perforated MD during elective hernia repair emphasizes the importance of awareness of unusual variants of inguinal hernia, and the necessity of identifying a MD given the risk of sequelae in the case of necrosis or perforation, if not repaired.

Littre's hernia-a reason for resection

Littre's hernias are exceedingly rare, with an estimated incidence of 0.09% in strangulated or incarcerated hernias. It may present as a complication of Meckel's diverticulum in less than 1%. In the adult population, it presents as an inguinal (50%), femoral (20%) and umbilical (20%) hernias. Management of Meckel's diverticulum when encountered during a routine repair of hernia in literature is generally resection. We present a case of a healthy 68-year-old gentleman who was found to have a Meckel's diverticulum in the indirect hernia sac during routine elective open right inguinal hernia repair.

Littré's Hernia: A Rare Intraoperative Finding

Littré’s hernia (LH) is a rare clinical entity defined by the presence of Meckel’s diverticulum (MD) within a hernial sac. Although MD is the most common congenital abnormality of the intestinal tract, most of its cases remain asymptomatic. It may, however, manifest itself in the form of multiple complications. One of its rare complications is LH, which is reported occurring in a mere 1% of all MD cases. The anamneses of LH are like any other hernia containing the gut, making its preoperative diagnosis unlikely. We present herein a case of a 16-year-old boy with an incarcerated LH at the inguinal region, which was successfully treated by wedge resection of the diverticulum followed by hernia repair.

Diverse presentations in pediatric Meckel's diverticulum: a review of 100 cases

BACKGROUND

Our objective was to analyze demographics and characteristics of Meckel's diverticulum with different manifestations in pediatric patients.

METHODS

This is a retrospective study in children with symptomatic Meckel's diverticulum who underwent resection between September 1998 and October 2010. The diagnosis was confirmed by surgery and pathology. Demographic characteristics, manifestations, Meckel's scan results, surgical and histological findings were analyzed.

RESULTS

One hundred symptomatic Meckel's diverticula were identified in 74 boys and 26 girls aged from one day to 18 years old over 13 years. Depending on whether or not obstruction occurred, the patients were classified into two categories. Each category was further subdivided into two diagnostic groups: 17 intussusception and 24 non-intussusception bowel obstruction in the obstructive category and 44 gastrointestinal bleeding and 15 diverticulitis and/or perforation in the non-obstructive category. The sex discrepancy was higher in the non-obstructive category than in the obstructive category (male-to-female, 4.36 vs. 1.73, p < 0.05). Forty-one of 44 patients with gastrointestinal bleeding underwent a Meckel's scan with a high positive rate (92.7%). The ectopic tissues were identified in 73 patients and included 61 gastric type, two pancreatic type and 10 mixed type. Ectopic tissues were more prevalent in non-obstructive category (p < 0.05) with ectopic gastric tissue even more pronounced (p < 0.01). Ectopic pancreatic tissue was significantly more prevalent in intussusception (p < 0.01). Laparoscopic surgery was performed more frequently in Meckel's diverticulum with non-obstructive symptoms (p < 0.001).

CONCLUSION

Diverse presentations in pediatric Meckel's diverticulum are affected by different ectopic tissue types and male sex. Laparoscopic surgery is widely used for children with non-obstructive symptoms.

Littre's hernia with an impalpable testis in a boy: a diagnostic dilemma

Littre's hernia is a rare clinical entity. The presence of a Littre's hernia in a 2-year-old boy with an impalpable testis is even rarer. We describe this interesting case with a review of the literature.