What type of hernia is characterized by the protrusion of a Meckel's diverticulum through the inguinal canal, with a long history of reduction and irreducibility, and difficulty in palpation?

Littre's Hernia

This clinical scenario describes a Littre's hernia (Answer C), which is defined by the presence of a Meckel's diverticulum within any hernia sac, most commonly presenting in the inguinal region (50% of cases). 1

Key Diagnostic Features

The scenario presents classic characteristics of Littre's hernia:

• Inguinal canal involvement with intestinal obstruction 1, 2
• History of reducibility followed by irreducibility - the Meckel's diverticulum may become incarcerated or strangulated within the hernia sac 1
• Difficulty with palpation - the diverticulum can be challenging to distinguish from standard bowel herniation on physical examination 3
• Persistent small bowel component - the Meckel's diverticulum remains attached to the ileum at the antimesenteric border, typically 30-90 cm from the ileocecal valve 1

Why Other Options Are Incorrect

• Richter hernia (Option A): Involves only a partial circumference of bowel wall protruding through the defect, not a Meckel's diverticulum 1
• Amyand hernia (Option B): Contains the appendix within an inguinal hernia sac, not Meckel's diverticulum
• Obturator hernia (Option D): Occurs through the obturator foramen in the pelvis, not the inguinal canal

Clinical Significance and Management

Littre's hernia represents a surgical emergency when complicated by incarceration or strangulation, requiring urgent operative intervention. 2, 4

Anatomical Distribution

• Inguinal location: 50% of cases 1, 5
• Umbilical: 20% 1, 5
• Femoral: 20% 1, 5

Complications

The Meckel's diverticulum within the hernia sac is prone to:

• Incarceration and strangulation with potential necrosis 1, 2
• Perforation if diagnosis is delayed 1
• Intestinal obstruction as described in this scenario 2, 3

Surgical Approach

Emergency repair consists of resection of the Meckel's diverticulum followed by standard herniorraphy. 1, 3

• Diverticulectomy or segmental resection depending on viability and Park criteria 2
• Careful field management to avoid contamination in perforated cases 1
• Standard hernia repair (e.g., Lichtenstein technique for inguinal hernias) after diverticulum resection 2

Diagnostic Challenge

Preoperative diagnosis is extremely difficult due to lack of specific clinical or radiological findings, with most cases diagnosed intraoperatively. 4, 3 The condition is clinically indistinguishable from standard small bowel herniation 3, making surgical exploration the definitive diagnostic and therapeutic approach 6.