CASE REPORT Richter’s hernia following operative laparoscopy

An obese 50-year-old lady underwent laparoscopicassisted vaginal hysterectomy and laparoscopic bilateral salpingo-oöphorectomy using our routine three-port technique (a subumbilical 10-mm port and two 12-mm lateral ports). The postoperative period was uneventful. On the 12th postoperative day the patient left the UK on a business trip to France. She returned three days later with vomiting once every night, mild diarrhoea and some colicky pain. The abdomen was soft and there was no tenderness of trocar site. She was admitted to hospital on the 18th postoperative day with suspected small bowel obstruction, as X-rays suggested mild distension of small bowel and fluid level. A laparotomy was performed on the 20th postoperative day. A Richter’s type hernia, involving part of the wall of the small bowel, was found between the peritoneal covering and sheath of the lateral abdominal wall at the site of a 12-mm port (Fig. 1). The hernia was released by simply pulling the bowel out of the hernia sac at laparotomy. The peritoneal defect was closed with one stitch. Following this, recovery was complete.