Recurrent Inguinal Hernia as Richter’s Hernia

An obese elderly gentleman of 85years presented with abdominal distension, vomiting and constipation of 2days duration. He was suffering from Parkinson’s disease and was disoriented. He had undergone surgery for left inguinal hernia about 40years ago, without a mesh. Examination revealed distension of abdomen with occasional bowel sounds. The groins and genitalia were normal. Since rectal examination revealed hard fecal matter, a clinical diagnosis of fecal impaction was made. Plain x ray and ultrasound revealed obstructed and dilated bowel. CT without contrast revealed a part of the sigmoid colon closely adherent to the inguinal region at the previous operation site. The patient was operated on emergent basis, through an inguinal incision, with the diagnosis of obstructed inguinal hernia. During surgery, in the hernia sac, the wall of the sigmoid colon was found to be incarcerated through the hernia defect (Figure 1), and the entrapped bowel wall was showing a dusky color. The ring was incised laterally, and the color of the bowel restored to normal slowly. The bowel was extracted further and found to be normal and viable and was returned into the abdominal cavity. The defect was closed with a polypropylene mesh to complete the repair. The patient had an uneventful recovery.