Case Report

An Unusual Presentation of Meckel Diverticulum as Strangulated Femoral Hernia

Authors: Evangelos Zacharakis, MD, Vasilios Papadopoulos, MD, Thanos Athanasiou, MD, PhD, FECTS, Paul Ziprin, MD, FRCS, Emmanouil Zacharakis, MD, PhD

Abstract

We report an unusual case of a patient with strangulated Meckel diverticulum in a femoral hernia. A 65-year-old woman presented with a nonradiating, constant pain in the right groin with associated nausea and anorexia. Physical examination revealed a tender, irreducible lump in the right groin area. At operation, a hernia sac containing a strangulated Meckel diverticulum was clearly recognized going through the femoral ring. A diverticulectomy was performed, and the femoral ring was closed with a polypropylene plug. No recurrence has been observed during the 3 year follow-up. Strangulated Meckel diverticulum in a femoral hernia remains a challenging diagnosis due to its extremely rare occurrence. Surgical exploration provides definite diagnosis of this rare condition.

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References

1. Perlman JA, Hoover HC, Safer PK. Femoral hernia with strangulated Meckel diverticulum (Littre's hernia): case report and review of the literature. Am J Surg 1980;139:286–289.
 
2. Turgeon DK, Barnett JL. Meckel diverticulum. Am J Gastroenterol 1990;85:777–781.
 
3. Cullen JJ, Kelly KA, Moir CR, et al. Surgical management of Meckel diverticulum: an epidemiologic, population-based study. Ann Surg 1994;220:564–569.
 
4. Mackey WC, Dineen P. A fifty-year experience with Meckel diverticulum. Surg Gynecol Obstet 1983;156:56–64.
 
5. DiGiacomo JC, Cottone FJ. Surgical treatment of Meckel diverticulum. South Med J 1993;86:671–675.
 
6. Williams RS. Management of Meckel diverticulum. Br J Surg 1981;68:477–480.
 
7. Sandblom G, Haapaniemi S, Nilsson E. Femoral hernias: a register analysis of 588 repairs. Hernia 1999;3:131–134.
 
8. Isaacs LE, Felsenstein CH. Acute appendicitis in a femoral hernia: an unusual presentation of a groin mass. J Emerg Med 2002;23:15–18.
 
9. Voitk AJ, MacFarlane JK, Estrada RL. Ruptured appendicitis in femoral hernias: report of two cases and review of the literature. Ann Surg 1974;179:24–26.
 
10. Rao PLNG, Gupta V, Kumar V. Anterior abdominal wall: an unusual site for ectopic testis. Pediatr Surg Int 2005;21:687–688.
 
11. Gurer A, Ozdogan M, Ozlem N, et al. Uncommon content in groin hernia sac. Hernia 2006;10:152–155.
 
12. Distasi AL. Unusual findings in hernia: supernumerary kidney [in Italian]. Rass Int Clin Ter 1966;46:875–880.
 
13. Naude GP, Ocon S, Bongard F. Femoral hernia: the dire consequences of a missed diagnosis. Am J Emerg Med 1997;15:680–682.
 
14. Moses WR. Meckel diverticulum: report of two unusual cases. N Engl J Med 1947;237:118–119.
 
15. Keynes WM. Richter's and Littre's hernias. 2nd edition. In: Nyhus LM,Condon RE, eds. Hernia. Philadelphia, JB Lippincott Co, 1978.
 
16. Castelden WM. Meckel diverticulum in an umbilical hernia. Br J Surg 1970;57:932–934.
 
17. Zuniga D, Zupanec R. Littre hernia. JAMA 1977;237:1599–1600.
 
18. Trupo F, Aburahma A. Meckel diverticulum in a femoral hernia: a Littre's hernia. South Med J 1987;80:655–666.