Enterocutaneous fistula secondary to Richter's femoral hernia in an elderly patient: A diagnostic pitfall - A case report

Abstract

Introduction

Richter's femoral hernia is a rare form of abdominal wall hernia at the femoral canal. The development of an enterocutaneous fistula (ECF) in this setting is extremely rare and highlights a rare but serious complication resulting from delayed presentation. It underscores the importance of early recognition and timely surgical intervention in resource-limited countries to prevent morbidity and mortality.

Case presentation

A 90-year-old woman from a remote village presented with lower abdominal pain, bilious vomiting, and a right groin wound. Examination revealed bilious discharge from the wound. Imaging showed an incarcerated right Richter's femoral hernia. After stabilization, she underwent emergency laparotomy with resection and anastomosis of the perforated ileal segment, followed by primary repair of the femoral defect. The patient recovered well and showed no recurrence at the 3-month follow-up.

Discussion

The development of a groin wound with an ECF in this context of Richter's femoral hernia is extremely rare. Differentiating this condition from similar presentations such as ruptured inguinal abscess, suppurative inguinal lymphadenopathy, or inguinal necrotizing fasciitis is crucial for timely intervention. A high index of suspicion and the use of advanced imaging modalities are necessary to delineate the pathology. Structured multidisciplinary care and a tailored surgical approach can lead to successful outcomes.

Conclusion

Spontaneous perforation of a Richter's femoral hernia resulting in an enterocutaneous fistula is an extremely rare and serious complication in the elderly with delayed presentation. High clinical suspicion, early recognition, and prompt surgical intervention are crucial for improving outcomes.