Journal of Postgraduate Medicine
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Year : 1989  |  Volume : 35  |  Issue : 2  |  Page : 112-3  

Littre's hernia in a child--an operative surprise (a case report).

KK Ravikumar, SS Khope, BP Ganapathi 
 

Correspondence Address:
K K Ravikumar


Abstract

The incidence of Littre«SQ»s hernia in children is unknown. The diagnosis is usually made at operation or autopsy. One case in an eight month old infant is described. Heterotropic mucoglandular tissue causing nodularity and adhesions was noted in the diverticulum. Though histological findings in Littre«SQ»s hernia are not mentioned in previous reports, we believe that Littre«SQ»s hernia could often be associated heterotropic mucosa.



How to cite this article:
Ravikumar K K, Khope S S, Ganapathi B P. Littre's hernia in a child--an operative surprise (a case report). J Postgrad Med 1989;35:112-3


How to cite this URL:
Ravikumar K K, Khope S S, Ganapathi B P. Littre's hernia in a child--an operative surprise (a case report). J Postgrad Med [serial online] 1989 [cited 2021 Apr 16 ];35:112-3
Available from: https://www.jpgmonline.com/text.asp?1989/35/2/112/5714


Full Text



 INTRODUCTION



Meckel was born 81 years after Alexis Littre (1658-1726) described a small bowel diverticulum in an inguinal hernial sac. It has been conjectured that what Littre described was actually what is now known as Richter's hernia.[4] The term Littre's hernia is retained for any hernia containing Meckel's diverticulum.

 CASE REPORT



V. H. (Hosp. No. 0358743), a healthy 8 month old male child was admitted to the paediatric surgical service with the history of a reducible swelling in the right inguinal region which was first noticed 15 days after birth. The child did not have any episode of gastro-intestinal bleeding or intestinal obstruction. Physical examination revealed a completely reducible right sided inguinal hernia.

At surgery, the contents of the hernial sac were found to be a loop of ileum with a Meckel's diverticulum, 4.5 cm long. [Fig. 1]. There were adhesions between the hernial sac and the tip of the diverticulum. The diverticulum felt nodular suggesting the presence of heterotropic mucosa.[1] The bands were divided, and as there was no inflammation or induration at the base of the diverticulum, wedge resection of its base was done, and the ileum closed. Herniotomy was then completed after reduction of the ileum into the abdomen. The child made an uneventful recovery.

On histopathological examination, the Meckel's diverticulum was found to be lined by jejunal, gastric, and colonic mucosa.

 DISCUSSION



Meckel's diverticulum is the persistent part of the omphalo-mesenteric duct, which, in the foetus, connects the midgut with the yolk sac. It may be located 10 to 150 cm from the ileocaecal valve and has an incidence of 0.3 to 2.5% with a male-to-female preponderance of approximately 3 to 2.[1]

The incidence of Littre's hernia in infants is unknown. In most cases, Meckel's diverticulum and Littre's hernia are incidental findings at surgery or postmortem. However, Littre's hernia should be suspected in the presence of rectal bleeding, irreducibility or a hernial faecal fistula.[2],[3]

Heterotropic tissue of gastric, duodenal, pancreatic or colonic morphology has been reported to occur in 6 to 17% of Meckel's diverticulum,[1] gross evidence of which could be nodularity and inflammatory adhesions.[3] Such adhesions between the diverticulum and the hernial sac may prevent a Meckel's diverticulum from returning to the abdomen, thus causing it to be a permanent content of the hernial sac.

The accepted treatment for Littre's hernia is wedge resection of the diverticulum and repair of the ileum from within the sac. Resection and anastomosis of a portion of the ileum may be necessary if there is induration or inflammation at the base of the diverticulum.

References

1Ellis, H.: Meckel's diverticulum; diverticulosis of small intestine; umbilical fistulae and tumours. In, "Maingot's Abdominal Operations." Vol. 11, 8th edition. Editors: S. I. Shwartz and H. Ellis and W. C. Hussers, Appleton-Century-Crofts, Norwalk, Connecticut, 1985, pp. 1085-1104.
2Leslie, M. D., Slater, N. D. and Small wood, C. J.: Small bowel fistula from a Littre's hernia. Brit. J. Surg., 70: 244, 1983.
3Mishalany, H. G., Pereyra, R. and Longerbean, J. K.: Littre's hernia in infancy presenting as undescended testicle. J. Paed. Surg., 17: 67-69, 1982.
4Penman, J. A., Hoover, H. C. and Safer P. K.: Femoral hernia with strangulated Meckel's diverticulum (Littre's Hernia) Case report and review of the literature. Anger. J. Surg., 139: 286-289, 1980.
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