Spontaneous entero-labial fistula complicating Richters hernia: Report of a case

BACKGROUND: Richter's hernia is defined as a type of hernia in which only part of the circumference of the antimesenteric border of a bowel wall is incarcerated within the hernia sac leading to ischemia, gangrene and perforation of the hollow viscus. Richter's hernia is known to cause strangulation without obstruction due to involvement of only a part of the circumference of a bowel wall. Inguino-labial Richter's hernia presenting with the complication of spontaneous entero-cutaneous fistula is rare. AIM: This is to report a case of spontaneous entero-labial fistula complicating Richters hernia occurring in an adult female. CASE REPORT: A 61-year-old woman presented with a history of sudden generalized abdominal pain. She had a prior history left inguino-labial swelling of six years duration, which was initially reducible but became irreducible two weeks prior to presentation. There was associated discharge from the swelling a few days later. She was pale and febrile. Her temperature was 39.2 °C, pulse rate was 110 per minute and blood pressure was 130/60 mmHg. A diagnosis of left inguinolabial hernia was made. She was resuscitated and an exploration of the groin swelling was made. A rupture of the anti-mesenteric border of the ileum with strangulated preperitoneal fat was found. She had resection and anastomosis of the ileum. CONCLUSION: Spontaneous faecal fistula in inguinal region following rupture of strangulated Richter's hernia especially in adults is uncommon and can occur even in absence of obstructive symptoms. In presentation of any groin swelling, there is need for an early accurate diagnosis followed by prompt treatment. The delay in its diagnosis and management may result in this rare complication of spontaneous faecal fistula. This reflects the state of health care in the developing world and needs to be addressed by the concerned authorities.