Enterocutaneous fistula due to a Richter's hernia after a Tenckhoff catheter removal.

Abstract

Richter's hernia is a rare type of hernia that occurs when the antimesenteric intestinal wall protrudes through a defect in the abdominal fascia leading to ischaemia, gangrene, bowel perforation and enterocutaneous fistulae. In this article, we describe a rare case of enterocutaneous fistula due to a Richter's hernia after a Tenckhoff catheter removal. This type of complication has not been previously reported in the literature. An 82-year-old man presented with a 1-day history of enteric content at the Tenckhoff catheter insertion site. Seven weeks earlier, the catheter was removed due to peritonitis. Removal was performed using open technique, and the fascia was not closed. Computed tomography revealed a small incarcerated hernia and subcutaneous fluid collection at the previous catheter insertion site. He underwent laparoscopy, which showed a Richter's hernia with perforation of the ileum causing an enterocutaneous fistula. A laparoscopic enterectomy was performed using a primary mechanical anastomosis. The hernia was repaired by primary suture without a mesh because of wound enteral contamination and the small size of the hernia. Richter's hernia has a misleading clinical presentation and contributes to high rates of morbidity and mortality. A secure myofascial closure during catheter removal may reduce the chances of this complication.