A Richter's hernia is most likely to be misdiagnosed because of which unique characteristic?

• A It contains the appendix and mimics appendicitis
• B It always occurs bilaterally in femoral hernias
• C Only part of the circumference of the bowel wall is trapped in the hernia sac, so bowel obstruction may be absent despite strangulation ✓
• D It contains the urinary bladder and causes urinary symptoms

Explanation

Richter's hernia is a hernia in which only part of the circumference of the bowel wall (usually the antimesenteric border) is trapped within the hernia sac. Because the bowel lumen is not completely obstructed, features of bowel obstruction (nausea, vomiting, absolute constipation) may be absent, making the diagnosis easily missed. However, the trapped bowel segment can undergo strangulation and necrosis, leading to perforation and peritonitis without preceding signs of obstruction. It most commonly occurs in femoral hernias. Early diagnosis is critical as strangulation can occur with minimal symptoms.

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.