Which of the following is content of Littre's hernia?
Ans. b (Meckel's diverticulum). (Ref. Bailey & Love, Surgery, 25lh/pg. 969, Ritcher Hernia (MH'2000)A Meckel's diverticulum = a Littre's hernia;An aphorism attributed to Dr. Charles Mayo: 'a Meckel's diverticulum is frequently suspected, often sought for and seldom found'.HerniasLittre's herniaMeckel's diverticulum is found in an inguinal or a femoral hernia sacRichter's herniaSac contains only a portion of the circumference of the intestine (usually small intestine). It usually complicates femoral and, rarely, obturator hernias.Dual(saddie bag; pantaloon)herniaConsists of two sacs which straddle the inferior epigastric artery, one sac being medial and the other lateral to this vessel.MAYDL'S hernia (SYN. HERNIA-IN-W).Strangulated loop of the "W" lies within the abdomen, thus local tenderness over hernia is not marked.Spigelian herniaA variety of interparietal hernia occurring at the level of the arcuate line, it is very rare with only 1000 cases reported in the literature.The fundus of the sac, clothed by extraperitoneal fat, may lie beneath the internal oblique muscle where it is virtually impalpable. More often it advances through that muscle and spreads out like a mushroom between the internal and external oblique muscles, and gives rise to a more evident swelling. The patient is often corpulent and usually over 50 years of age, men and women being equally affected. Typically, a soft, reducible mass will be encountered lateral to the rectus muscle and below the umbilicus.Diagnosis is confirmed by computerised tomography (CT) or ultrasound scanning, the latter having the advantage of being able to stand the patient upright if no defect is visible in the reclining position. Owing to the rigid fascia surrounding the neck, strangulation may occur.Lumbar herniaMost primary lumbar hernias occur through the inferior lumbar triangle of Petit, bounded below by the crest of the ilium, laterally by the external oblique and medially by the latissimus dorsi.Less commonly, the sac comes through the superior lumbar triangle which is bounded by the twelfth rib above, medially by the sacrospinalis and laterally by the posterior border of the internal oblique.More commonly lumbar hernias are secondary to renal operations, when extensive incisional sacs may be present.Educational Points:The rule that constipation is present in intestinal obstruction does not apply in:# Richter's hernia;# Gallstone obturation;# Mesenteric vascular occlusion;# Obstruction associated with a pelvic abscess;# Partial obstruction (faecal impaction/colonic neoplasm) where diarrhoea may often occur.
Urinary bladder
Meckel's diverticulum
Circumference of intestinal wall
Appendix
Hernia