A large incarcerated Meckel's diverticulum in an inguinal hernia

Introduction: Littre's hernia is a rare finding consisting of a Meckel's diverticulum inside of a hernia sac. Clinically, it is indistinguishable from a hernia involving small bowel and therefore may be difficult to diagnose pre-operatively.

Presentation of case: We report a case of an inguinal hernia involving an unusually large Meckel's diverticulum measuring 15cm in length. The diverticulum was resected using a linear GI stapler and the hernia was repaired without complication.

Discussion: Meckel's diverticulum is an embryologic remnant of the vitelline duct occurring in 1-3% of the adult population with an estimated 4% becoming complicated and presenting with intestinal obstruction, infection, bleeding or herniation. Surgical resection is the recommended treatment for any Meckel's diverticulum causing symptoms. In the case of a Littre's hernia, resection of the diverticulum should be followed by repair of the fascial defect in a standard fashion.

Conclusion: Littre's hernia, although rare, should be a consideration at the time of repair for any abdominal hernia involving small bowel as resection of the Meckel's diverticulum is critical in avoiding recurrent complications.