DOI  10.17613/tgj52-5d932 

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Case Reports

Perforated Richter’s Femoral Hernia: An Unusual Cause of Acute Intestinal Obstruction – Case Report and Literature Review

Carrera-Holguín Alejandra*¹; Estrada-Chacón Cecilia Estefanía¹; Castañón-Pérez Giselle Anyul¹; Ruiz-Ruelas Carlos Alejandro¹; Meza-Ascencio Bryan Ari Guadalupe²; Robledo-Tijerina Ángel Salvador¹; Díaz-García Maximiliano¹; Chacón-Sifuentes Ciglady Angélica¹.

*Correspondence: alejandracarreraholguin@gmail.com ORCID: 0009-0002-2536-4137

¹Department of General Surgery, General Hospital of Torreón, Torreón, Coahuila, Mexico.

²Department of Surgery, Hospital Civil Tepic “Dr. Antonio González Guevara”, Tepic, Nayarit, Mexico.

Keywords: Femoral hernia, Richter’s hernia, intestinal obstruction, bowel perforation, emergency surgery, intestinal anastomosis.

Abstract: Richter’s hernia is an uncommon variant of abdominal wall hernias, characterized by the entrapment of only the antimesenteric portion of the intestinal wall, which may progress to ischemia and perforation in the absence of overt luminal obstruction. Its occurrence within the femoral canal is rare and poses significant diagnostic and therapeutic challenges, particularly in older adults with atypical clinical presentations. We report the case of a 90-year-old female patient who presented with a 5-day history of abdominal distension, escalating pain, and obstipation. Physical examination revealed a tender, irreducible right inguinal mass suggestive of incarcerated hernia, along with clinical features of intestinal obstruction. Emergent laparotomy identified a perforated Richter’s hernia within the femoral canal, involving a 2 cm ischemic segment of terminal ileum located 40 cm proximal to the ileocecal valve. Surgical management included segmental small bowel resection with primary end-to-end anastomosis and prosthetic repair of the femoral defect using a polypropylene mesh. The initial postoperative course was satisfactory. This case underscores the need for high clinical suspicion in the differential diagnosis of groin hernias with obstructive symptoms and highlights the importance of prompt surgical intervention to prevent morbidity associated with delayed diagnosis.