A 70-year-old woman presents with a femoral hernia containing a Richter's hernia. What is the defining characteristic of a Richter's hernia and why is it particularly dangerous?

• A Contains Meckel's diverticulum; risks diverticulitis
• B Contains only the antimesenteric wall of bowel; may strangulate without complete obstruction ✓
• C Contains two loops of bowel in a W configuration; risk of missed ischemia
• D Contains sliding sigmoid colon; risks sigmoid perforation on reduction

Explanation

Richter's hernia involves only the antimesenteric border (knuckle) of the bowel wall being entrapped in the hernia sac, not the full bowel lumen. Because the bowel lumen is not fully occluded, intestinal obstruction may be absent or incomplete, delaying diagnosis. The entrapped bowel segment can strangulate and perforate without symptoms of obstruction. It occurs most commonly in femoral hernias due to the rigid femoral ring. Littre's hernia contains Meckel's diverticulum; Maydl's (W hernia) involves two bowel loops in a W configuration; sliding hernia involves a retroperitoneal organ forming part of the sac wall.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.