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Richter Hernia

Richter Hernia

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Richter hernia is named after the German surgeon August Gottlieb Richter who first described it in 1778. Richter hernia refers to the protrusion of the circumference of the antimesenteric part of the small bowel through a defect in the abdominal wall.

The defect on the abdominal wall leading to the Richter hernia is often rigid and small causing the hernia to strangulate easily.

Owing to its high strangulation rate Richter hernias must be repaired immediately upon diagnosis.

What is a Richter Hernia?

A Richter hernia is a protrusion of the antimesenteric border of the small intestine through the femoral or inguinal ring or incisional defects on the abdominal wall.

Richter hernias protrude most often through the femoral ring and are common in men and women over 70 years of age.

Richter hernias are prescribed with surgical repair as they cannot be managed without surgery.

Symptoms of Richter Hernia

Richter hernias do not exhibit enough clinical symptoms until strangulation. So it is often difficult to diagnose a Richter hernia.

A complicated Richter hernia however exhibits symptoms such as:

  • Pain in the lower abdomen
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation

Causes of Richter Hernia

The causes of a Richter hernia include

  • Weakening of the abdominal wall due to old age
  • Unhealthy lifestyle practices
  • Doing strenuous physical activities
  • Multiple pregnancies
  • Obesity
  • Incisional trauma, etc.

Sites of Richter Hernia

Richter hernias can occur in the following sites:

  • Femoral rings
  • Inguinal rings
  • Weak sites on the abdominal wall
  • Surgical incision sites on the abdomen

Richter Hernia Complications

Strangulation, obstruction, and incarceration of the hernia are the complications of a Richter hernia. The risky part about a Richter hernia is its easy strangulation.

The primary reason for a Richter hernia to get strangulated easily is the small defective region of the abominable wall through which only the antimesenteric border of the small intestine passes. Since not more than one-third of the intestine passes through the opening obstruction of the hernia does not take place but the narrow and rigid weak spots or openings strangulate the intestine easily.

A strangulated Richter hernia often leads to gangrene and other fatal complications. If a Richter hernia begins to cause severe ailments, it indicates that the hernia has become complicated and requires immediate medical attention.

Treatment for Richter Hernia

The ultimate treatment for Richter hernia is surgical intervention. Based on physical examinations and imaging tests like ultrasound or computed tomography (CT), the Richter hernia is first diagnosed.

The choice of surgical approach is based on factors such as the location of the hernia, the health state of the patient, the severity of the hernia, and the preference of the surgeon.

A complicated hernia is mostly repaired via open surgery. However, laparoscopic and robotic surgeries are employed as well.

Preventing Richter Hernia

Richter hernias may occur due to the inevitable weakening of the abdominal wall with increasing age. However, you can try to minimize the risk of the occurrence of a Richter hernia by:

  • Taking a fiber-rich diet
  • Getting enough rest after an abdominal surgery
  • Not undertaking strenuous physical activities
  • Avoiding smoking, excess alcohol consumption, and drugs
  • Maintaining a healthy BMI
  • Doing moderate exercises, etc.

Conclusion

A Richter hernia must be treated with the utmost priority as it can escalate into a strangulated hernia easily.

If you have had any abdominal surgeries earlier, be on the lookout for Richter hernias as incisional traumas lead to Richter hernias more often.

Richter hernias can be treated via modern and advanced surgical procedures. So, reach out to a hernia specialist immediately to prevent any adverse circumstances and for quicker recovery from the hernia.

To know more about Richter hernias and how to deal with them, contact a hernia specialist.

FAQs

1) Do Richter hernias need surgery?

Yes, a Richter hernia requires surgical intervention to prevent complications. Since a Richter hernia can get strangulated quickly it is best to repair a Richter hernia electively.

2) How do you fix a Richter hernia?

Richter hernias are fixed through laparotomy or laparoscopic surgeries. Richter hernias are prone to faster strangulation so surgical fixation of the hernia is recommended most often.

3) Can you live with a Richter hernia?

You can live with a Richter hernia until it gets complicated. A complicated Richter hernia must face surgical repair to avoid fatal consequences. Due to its high strangulation rates, Richter hernias cannot be managed without surgery.

Dr. K. Amilthan MBBS., MS., FMAS., FALS.

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