RICHTER'S HERNIA AS AN UNUSUAL COMPLICATION FOLLOWING LAPAROSCOPIC APPENDECTOMY.

Abstract

Introduction: Incisional hernia at the trocar site (TIH) is a known complication of laparoscopic surgery. An uncommon variant is Richter's hernia, where only the antimesenteric border of the intestine protrudes. Its clinical presentation is often insidious, with a risk of incarceration and strangulation. This report describes a case of Richter's hernia as an atypical complication following a laparoscopic appendectomy. Case report: A 52-year-old female patient underwent a laparoscopic appendectomy for acute perforated appendicitis, using 10 mm and 5 mm ports. On the fourth postoperative day, she presented with localized abdominal pain, distension, and constipation. A computed tomography scan revealed a fascial defect in the left iliac fossa with protrusion of a small bowel loop. Laparoscopic intervention confirmed an incarcerated Richter's hernia with viable intestine. The hernia was reduced, and the fascial defect was closed with polydioxanone suture and a preperitoneal polypropylene mesh was placed. The patient had a favorable outcome. Conclusion: Although rare, Richter's hernia can occur even at 10 mm port sites. Systematic fascial closure is recommended for ports ?10 mm, and a high index of clinical suspicion should be maintained in the postoperative period for patients with obstructive symptoms to ensure early diagnosis and treatment, thereby reducing associated morbidity.