Abstract
Introduction The Littre hernia is a rare complication of Meckel's diverticulum. Meckel's diverticulum
is vestigial remnant of the omphalomesenteric duct occurring in approximately 2% of
the general population with an estimated 4 to 16% risk of complications. Usual sites
of the Littre hernia include inguinal (50%), umbilical (20%), and femoral (20%). We
report a case of an acquired transthoracic Littre's hernia occurring through the left
part of the diaphragm triggered by a history of traumatic rib fractures associated
with alcohol abuse.
Case Report A 71-year-old man presented with 4-day history of worsening shortness of breath,
colicky lower abdominal pain, and inability to open bowels despite passing flatus,
without nausea or vomiting. His past medical history was remarkable for multiple traumatic
rib fractures caused by falls which were associated with excessive alcohol consumption.
A noncontrast computed tomography (CT) scan of the abdomen and pelvis showed distended
jejunal loops containing air/fluid levels likely resulting from herniated jejunum
between the left chest wall and left diaphragm. An urgent laparotomy was performed
which revealed small bowel and omentum herniating through a small defect in the left
posterior hemidiaphragm. The contents of the sac were reduced and a Meckel's diverticulum
was found inside the sac, characteristic of Littre's hernia. The diaphragmatic defect
was closed and the Meckel diverticulum stapled and excised.
Discussion Herniation of Meckel's diverticulum through the diaphragm most commonly occurs in
the pediatric population. Acquired transthoracic Littre's hernia is rare and may arise
following thoracobdominal trauma caused by surgery, motor vehicle accidents, and falls
from height. Left-diaphragmatic tears are characteristically more clinically apparent
and symptomatic than the right since the liver often has a protective effect on the
right part of the diaphragm. Herniation of abdominal contents in the chest cavity
causes respiratory distress and requires urgent surgical correction. Diagnosis is
often delayed since diaphragmatic hernia tends to present very late after the initial
trauma, subjecting the patient to possible life-threatening complications. While it
is easier to reduce the herniated contents and repair the diaphragm via a thoracic
approach, laparotomy is often preferred in cases of acute trauma associated with intra-abdominal
injuries. Repair of Littre's hernia then consists of resection of the diverticulum
and herniorraphy.
Conclusion Internal Littre's hernia is usually of congenital origin. This is the first case
of a transthoracic Littre's hernia caused by traumatic rib fractures. Hence, it is
of utter importance that a clinician is aware of such uncommon pathology.
Keywords
case report - Meckel's diverticulum - Littre's hernia - diaphragmatic defect - transthoracic
- acquired
