Enterocutaneous fistula secondary to Richter's femoral hernia in an elderly patient: A diagnostic pitfall - A case report
Year: 2025
Type: article
Study design: Case Report
Abstract: Richter's femoral hernia is a rare form of abdominal wall hernia at the femoral canal. The development of an enterocutaneous fistula (ECF) in this setting is extremely rare and highlights a rare but serious complication resulting from delayed presentation. It underscores the importance of early recognition and timely surgical intervention in resource-limited countries to prevent morbidity and mortality. A 90-year-old woman from a remote village presented with lower abdominal pain, bilious vomiting, and a right groin wound. Examination revealed bilious discharge from the wound. Imaging showed an incarcerated right Richter's femoral hernia. After stabilization, she underwent emergency laparotomy with resection and anastomosis of the perforated ileal segment, followed by primary repair of the femoral defect. The patient recovered well and showed no recurrence at the 3-month follow-up. The development of a groin wound with an ECF in this context of Richter's femoral hernia is extremely rare. Differentiating this condition from similar presentations such as ruptured inguinal abscess, suppurative inguinal lymphadenopathy, or inguinal necrotizing fasciitis is crucial for timely intervention. A high index of suspicion and the use of advanced imaging modalities are necessary to delineate the pathology. Structured multidisciplinary care and a tailored surgical approach can lead to successful outcomes. Spontaneous perforation of a Richter's femoral hernia resulting in an enterocutaneous fistula is an extremely rare and serious complication in the elderly with delayed presentation. High clinical suspicion, early recognition, and prompt surgical intervention are crucial for improving outcomes. • Richter's femoral hernia complicated by spontaneous enterocutaneous fistula is extremely rare. • Subtle symptoms and incomplete bowel obstruction may delay diagnosis. • Contrast-enhanced CT is essential for accurate diagnosis in atypical groin presentation. • Early recognition, prompt stabilization and surgical intervention are crucial for favorable outcomes. • Awareness of this complication is especially important in elderly patients and low-resource settings.
Authors: Sabin Kumar Ghimire, Rahul Jha, Samrat Shrestha, Rabin Kumar Ghimire, Suresh Maharjan, Niliza Shakya
Institution: National Academy of Medical Sciences
Language: English
Topic: Hernia repair and management
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,090
OpenAlex ID: W4414569112