in newborn infants: Report of two cases.
One of the most common cause of paediatric surgical referral is inguinal hernia.1 Its reported prevalence in mature infants is upto 15% while it is slightly higher in pre-mature infants where it is reported to be between 10-30%.1,2 Its cause is failure of closure of processus vaginalis in children and it may contain all types of contents such as ovaries, fallopian tubes, Meckel's diverticulum, gut etc.3 Depending upon the type of unsual contents; these hernias are named differently as Littre's hernia
if the sac contains Meckel diverticulum or Richter henia if the sac contains a portion of the circumference of intestine.3,4 Both these types are quite well known in literature but there is a third type which is relatively not very well known, called as Amyand's hernia.
Small bowel obstruction can be the result of intussusception, volvulus around a fibrous band between Meckel's diverticulum and umbilicus, internal hernia through a fibrous band or an aberrant vitelline artery, prolapse of Meckel's diverticulum through a persistent omphalomesenteric effect, Littre's hernia
, and rarely, enterolithiasis [1, 2, 4].
(1) In an estimated 4% of cases, medical or surgical intervention is required to treat complications involving Meckel's diverticulum such as bowel obstruction, diverticulitis, hemorrhage and rarely, hernias containing a Meckel's diverticulum (Littre's Hernia
[sup] There are have been many case reports in the literature regarding the contents of strangulated inguinal hernia such as ovary, fallopian tube, gangrenous bladder diverticula, large bowel diverticula, and Meckel's diverticulum (Littre's hernia
in infancy presenting as indescended testicle.
Salemis, "Incarceration of Meckel's diverticulum through a ventral incisional defect: a rare presentation of Littre's hernia
," Hernia, vol.
The bladder, a Meckel's diverticulum (Littre's hernia
), or a portion of antimesenteric wall of small intestine (Richter's hernia) can also be encountered as unusual contents.
Only 4% of people with this pathology develop complications, which includes obstruction, hemorrhage, inflammation, perforation, neoplasia and Littre's hernia
. (5,6) There are various mechanisms causing intestinal obstruction like intussusceptions, volvulus, Littre's hernia
, enterolith, stricture, entangling of a loop of bowel around a fibrous cord, neoplasm, and so forth.
Obstruction can be caused by trapping of a bowel loop by a mesodiverticular band, a volvulus of the diverticulum around a mesodiverticular band, and intussusception, as well as by an extension into a hernia sac (Littre's hernia
In another case incidentally Meckel's diverticulum was found as a content of right sided inguinal hernia (Littre's hernia
Since then the hernia sacs containing only Meckel's diverticula are termed as Littre's hernia
. Although Littre's original report related to femoral hernias, 50% of the Meckel's diverticula are in inguinal hernias, 20% in femoral, 20% in umbilical and remaining 10% in other miscellaneous hernias (6, 7, 8).