A Richter's hernia strangulates. Which specific feature distinguishes it from other strangulated hernias and makes it especially dangerous?

• A It involves the entire bowel circumference and obstructs completely
• B It contains both small and large bowel simultaneously
• C It always contains the appendix as the incarcerated structure
• D Only the antimesenteric wall of the bowel is caught, allowing intestinal continuity with no obstruction despite strangulation ✓

Explanation

In a Richter's hernia, only the antimesenteric border (knuckle) of the bowel wall is herniated and strangulated, without involvement of the full lumen. This means intestinal continuity and transit are maintained, so the patient does not develop classic complete intestinal obstruction symptoms (absolute constipation, gross distension) despite having gangrenous bowel wall. The presenting feature may be only a tender irreducible swelling with vague abdominal discomfort, leading to diagnostic delay and peritonitis from perforation.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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