RIGHTERS HERNIA - A SURGICAL PITFALL

BACKGROUND: Although Richter's hernia was first described in 1598, lit tle attention has been given to this topic in recent literature. The d iagnosis of Richter's hernia is difficult because of the innocuous dev elopment of signs and symptoms and it is associated with a high mortal ity rate. Awareness of this relatively rare surgical entity is importa nt. STUDY DESIDN: Of 350 patients with incarcerated hernias who underw ent operation between 1911 and 1994 at the Department of Surgery ''A'' Assaf Harofeh Medical Center, 14 had strangulated Richter's hernia. A retrospective study was carried out in order to characterize the clin ical manifestations of Richter's hernia and to assess preoperative del ay, hospital stay, and complication and mortality rates, A comparison study was made with matched patients with strangulated hernias of non- Richter's type, Differences in morbidity and mortality rates, preopera tive delay, and hospital stay of patients with Richter's hernias and t he comparison group were evaluated. RESULTS: Of 14 patients with Richt er's hernia, seven underwent intestinal resection. The hernia most com monly occurred at the femoral and inguinal sites. Compared with patien ts with other hernias, patients with Richter's hernias had greater pre operative delay, rate of bowel resection, length of hospital stay, and postoperative morbidity and mortality rates. CONCLUSIONS: Early opera tive intervention is the mainstay of successful management of Richter' s hernia and awareness of this disease and its misleading clinical pre sentation is of utmost importance.