RESUMO
INTRODUCTION AND IMPORTANCE: Richter's hernia is a protrusion of a portion of the circumference of anti-mesenteric side of intestine through the fascial defect. It is a rare type of hernia and typically occurs in elderly patients. Richter's hernia could result in grave complications. The objective of the study was to describe a rare case of incarcerated Richter's congenital umbilical hernia in a 20-year-old male patient. CASE PRESENTATION: A 20-year-old male presented with a complaint of intermittent crampy peri-umbilical pain of three days duration associated with non-reducible umbilical bulge and vomiting. On examination, there was 4 cm by 4 cm oval, firm, tender, non-reducible mass over the umbilical area without cough impulse. He was kept nothing per os, broad spectrum antibiotic started, consent taken & operated. A loop of the ilium which was mildly ischemic found in the hernia sac. Sac and entrapped intestine were thoroughly cleaned with warm saline and reduction and herniorrhaphy done. The client discharged on the 2nd postoperative day. CLINICAL DISCUSSION: There have been very few reports of Richter's congenital umbilical hernia. Richter's hernia progresses more rapidly to gangrene than other strangulated hernias however patients often have no intestinal obstruction. Raised suspicion therefore is important to take timely surgical intervention before the disease advance and complications occurred. CONCLUSION: Richter's hernia has subclinical symptoms and late presentation which could result in grave complications and increased mortality. The early decision for surgery has paramount importance in reducing complication and associated mortality.
RESUMO
INTRODUCTION AND IMPORTANCE: Ascariasis is a helminthic infection of humans caused by Ascaris lumbricoides. Intestinal obstruction from ascariasis can result in a rare but severe and often fatal surgical emergency of intestinal perforation and peritonitis in endemic areas. There have been reports of ascariasis causing Small Bowel Obstruction (SBO) in children in endemic areas but this phenomenon has not been studied in adults. The objective of this study was to describe the case of ascariasis causing SBO in a 25-year-old female. CASE PRESENTATION: A 25-year-old female from southwest Ethiopia presented with a complaint of intermittent crampy abdominal pain of 02 days duration associated with vomiting of ingested matter of 02 to 03 episodes, progressive abdominal distension and failure to pass feces and flatus. On examination, she was acutely sick looking. She has mild abdominal distention and a hyperactive bowel sound. Subsequently, she was resuscitated, broad spectrum antibiotic started, consent taken & operated. Patient discharged on the 7th postoperative day. CLINICAL DISCUSSION: There have been reports of Ascariasis causing SBO in endemic areas of the tropics and sub-tropics. SBO secondary to the ascaris ball in an adult is very rare and is relevant to present as it adds key clinical lessons in the consideration as a differential diagnosis, investigation clues and patient management. CONCLUSION: In a patient presented with symptoms and signs suggestive of bowel obstruction, Ascariasis should be considered as a differential diagnosis for those from endemic areas. The treating physician should have a high index of suspicion.
