Surgical Approach to Littre's Hernia: A Rare Presentation of Meckel's Diverticulum.

Abstract

BACKGROUND Littre's hernia is a rare entity defined as the herniation of a Meckel's diverticulum through a defect in the abdominal wall. Although Meckel's diverticulum occurs in up to 2% of the population, its manifestation within a hernia is extremely rare, comprising around 1% of Meckel's cases. This report describes the case of a 32-year-old man presenting as an emergency with lower abdominal pain and a diagnosis of Littre's hernia. CASE REPORT A 32-year-old man presented with a 3-day history of lower abdominal pain and periumbilical erythema. Clinical examination revealed an irreducible umbilical hernia. Laboratory tests showed leukocytosis and elevated CRP. A CT scan suggested an incarcerated hernia with signs of ischemia, but no clear identification of Meckel's diverticulum. Diagnostic laparoscopy followed by mini-laparotomy revealed a necrotic Meckel's diverticulum 110 cm proximal to the ileo-cecal valve. A stapled diverticulectomy was performed without mesh repair due to contamination. The wound was managed with a vacuum-assisted closure (VAC) system. The postoperative course was uneventful, and histopathology confirmed necrotizing inflammation without malignancy. CONCLUSIONS Littre's hernia is a rare but important differential diagnosis in abdominal wall hernias and can present symptomatically as an acute abdomen. This case highlights the presentation, diagnosis, and surgical management of an atypical umbilical Littre's hernia and reinforces the value of prompt surgical exploration and intraoperative assessment to avoid ischemic complications.