Richter's hernia and Sir Frederick Treves: An original clinical experience, review, and historical overview

Objective To describe the clinical recognition, pathology, and management of Richter' s hernia and to review the relevant literature of the past 400 years. Summary Background Data The earliest known reported case of Richter's hernia occurred in 1598 and w as described by Fabricius Hildanus. The first scientific description of thi s particular hernia was given by August Gottlob Richter in 1778, who presen ted it as "the small rupture." In 1887, Sir Frederick Treves gave an excell ent overview on the topic and proposed the title "Richter's hernia." To his work-a cornerstone to modern understanding - hardly any new aspects can be added today. Since then, only occasional case reports or small series of r etrospectively collected Richter's hernias have been published. Methods The authors draw on their experience with 18 prospectively collected cases treated in the ICRC Lopiding Hospital for War Surgery in northern Kenya bet ween February and December 1998 and review the relevant literature of the p ast 400 years. Results The classic features of Richter's hernia were confirmed in all case studies of patients: only part of the circumference of the bowel is entrapped and strangulated in the hernial orifice. The involved segment may rapidly pass into gangrene, yet signs of intestinal obstruction are often absent. The de ath rate in the authors' collective was 17%. Conclusion Richter's hernia is a deceptive entity whose high death rate can be reduced by accurate diagnosis and early surgery. Considering the increasing incide nce at laparoscope insertion sites, awareness of this special type of herni a with its misleading clinical appearance is important and of general inter est.