A 50-year-old man presents with a tender, irreducible femoral swelling. At surgery, only part of the circumference of an ileal loop is trapped in the hernial ring. There are signs of venous congestion in the entrapped segment, yet the patient reports no distension and continues to pass flatus. This clinical picture is explained by:

• A Incarceration of omentum alone with reactive inflammation
• B Complete luminal occlusion with rapid adaptation of proximal bowel
• C Partial circumference involvement allowing luminal continuity despite strangulation ✓
• D Intermittent spontaneous reduction of the hernia contents

Explanation

C Richter hernia traps only the anti-mesenteric border of the bowel wall, so the lumen remains partially patent. Strangulation with ischaemia can therefore occur without complete intestinal obstruction, explaining absent distension and continued passage of flatus. This delay in classical obstructive signs makes Richter hernias dangerous because diagnosis is late. Omental incarceration cannot produce bowel wall ischaemia, and intermittent reduction would relieve the tenderness and congestion.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.