Akademik Veri Yönetim Sistemi
American Journal of Emergency Medicine, cilt.26, sa.8, 2008 (SCI-Expanded)
Meckel diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract that is generally asymptomatic and only manifests in a specific way when complications exist. An unusual complication of MD is known as Littre hernia. It comprises less than 1% of all MD. Littre hernia is the protrusion of an MD through a potential abdominal opening. Usual sites of Littre hernia are right inguinal (50% of cases), umbilical hernia (20%), and femoral hernia (20%). We report a case of Littre hernia in a boy who presented with acute scrotal pain and swelling. Meckel diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract that is generally asymptomatic and manifests only in a specific way when complications exist. Only 1% to 4% of patients with MD develop hemorrhage, inflammation, obstruction, or perforation [1]. The definition of Littre hernia is based upon the protrusion of an MD through a potential abdominal opening accompanied in some cases by incarceration, inflammation, or necrosis. The most common site of Littre hernia is the inguinal canal (50%), usually on the right [2]. Strangulation of an MD in Littre hernia is extremely rare. We report a case of Littre hernia in a boy who presented with acute scrotal pain and swelling. A 7-year-old boy was admitted to our department with acute right-sided hemiscrotum. As we learned from his mother, the boy had a history of intermittent pain accompanying anorexia, abdominal distention, for 3 days. On physical examination, abdominal distention with a tender and erytamatous swelling at the right inguinoscrotal region was seen. A plain film of abdomen showed dilated intestinal loops with air-fluid levels. On the basis of these findings, he underwent emergent inguinoscrotal exploration through right inguinal incision for acute hemiscrotum. A fluid-filled hernial sac containing an inflamed MD was found (Fig. 1). The diverticulum was resected with a linear cutter (GIA 60-mm linear stapler; Ethicon, San Angelo, TX). The cystic hernial sac was ligated and the operation was terminated. The postoperative course was uneventful. The histological examination confirmed an inflamed MD, lined by normal ileal and heterotopic gastric mucosa. Littre hernia is the protrusion of an MD through a potential abdominal opening [3]. In 1700, French surgeon Alexandre de Littre described for the first time a new form of inguinal hernia. This hernia varied from the known forms of hernias in its clinical course and in the postmortem examination results performed by Littre himself [4]. Although MD is a relatively common anomaly, herniation of these embryological remnants is an exceedingly rare event. It is difficult to diagnose Littre hernia preoperatively unless a complication occurs [5]. The management of an asymptomatic and incidentally detected MD is controversial. Factors such as younger age, male sex, diverticular length greater than 2 cm, and presence of ectopic epithelium are considered as potential risk factors for complications [6]. The most common site (50% of cases) is the inguinal canal, usually on the right, although cases of umbilical hernia (12%-30%) and femoral hernia (19%-30%) have also been reported fairly frequently [7]. In most cases, Littre hernia is an incidental finding at surgery. The most usual treatment of Littre hernia is wedge-shaped resection of the base of the diverticulum from the inside of the hernial sac. Closure of the hernial sac is then carried out in the usual way. Ileal resection is performed only when damage is severe [2]. Although the boy's parent did not have inguinal hernia history, we took into account that the cause of acute hemiscrotum could be an incarcerated inguinal hernia primarily because of the intestinal obstruction findings. After opening the hernia sac, we found that there was only inflammation of MD and reactional fluid despite small bowel ischemia. Treatment was excision of the MD and repair of the hernia [7]. This case showed the importance of considering incarceration or strangulation and acute before perforation or fecal fistula occurs, which could increase the risk of severe complications. In conclusion, repair of Littre hernia consists of resection of the MD and herniorrhaphy; in perforated cases, care must be taken to not contaminate the hernia field. Crown Copyright © 2008.