Umbilical Littre hernia: A rare case report of an acute abdomen

Abstract

Introduction

Littre's hernia (LH) is due to the presence of a Meckel's diverticulum (MD) in a hernial sac. It is an extremely rare condition in less than 1 % of all MD cases. It is often asymptomatic and is diagnosed incidentally during routine surgery for hernia repair. Surgery is the main treatment. Although the management of uncomplicated MD remains controversial, MD's management in the setting of either bowel obstruction or of Littre's hernia is done according to the clinical principles combined with the availability of local expertise.

Presentation of case

We report a case of an 11-year-old boy presented to the emergency room with a diagnosis of acute obstructive syndrome. Radiological exams were inconclusive. Intra-operatively findings showed a strangulated MD trapped in a small umbilical hernia. A simple wedge resection, followed by a primary closure of the remaining defect was performed. During 12 months of observation the patient remains in good condition.

Discussion

LH is an uncommon type of abdominal wall hernia. Preoperative diagnosis is difficult.

Even abdominal ultrasound and computed tomography (CT) cannot reveal the right diagnosis and it is generally performed intraoperatively. The main treatment is surgery. Repair of a Littre hernia requires both management of Meckel's diverticulum and repair of the hernia with sutures or mesh.

Conclusion

LH is a very rare type of hernia. Diagnosis is very difficult. All surgeons should be aware of this type of hernia to avoid life-threatening complications. The application of hernia repair recommendations for children may anticipate the happening of complicated LH.

Highlights

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  Littre's hernia is a rare condition due to the presence of a Meckel's diverticulum in a hernial sac.

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  The diagnosis is usually delayed because symptoms are non-specific.

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  It represents a surgical emergency due to the risk of gangrenous bowel.

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  The application of hernia repair recommendations for children may anticipate the happening of complicated LH.