Richter Hernia

A Richter hernia is an abdominal wall hernia where only a part of your intestine gets stuck in the defect, versus the full thickness of your intestine getting stuck. Instead of a whole piece of intestine pushing through a gap in your tissues, just the outer side of the piece does. This is relatively rare. It usually happens in a small, tight space, where a gap in your tissues already exists.

Common places where a Richter hernia might occur are in:

• Small cuts (incisions), like laparoscopic surgery ports (incisional hernia)
• Your femoral canal (femoral hernia)
• Your inguinal canal (inguinal hernia)

A Richter hernia may be harder to find than other hernias that involve the full thickness of your bowel. You may not see a bulge or have obvious symptoms. At the same time, a Richter hernia is more likely than others to get stuck (incarcerated). And it can get cut off (strangulated) from its blood supply.

Symptoms of a Richter hernia

A Richter hernia may cause symptoms like:

• Abdominal pain or discomfort
• Nausea and vomiting
• Swelling in your belly or groin

A Richter hernia that’s stuck and strangulated may become increasingly painful. But because it’s not a whole piece of your bowel that’s stuck, it usually won’t cause symptoms of a bowel obstruction. You may have some digestive discomfort. But you’ll still be able to eat, poop and pass gas normally.

Richter hernia causes

Richter hernias usually happen when there’s already an opening or “defect” in your fascia. Fascia is the connective tissue of your abdominal wall that covers your muscles. The hernias happen in small openings that don’t stretch. They’re just big enough for the edge of your bowel to poke through, but not the whole piece.

Hernias can get into the small canals in your groin when there’s a small gap in your lower abdominal muscles. Aging leads to weakening of the tissues over time. Hernias can also come through small surgical incisions if they don’t close all the way.

Risk factors

Most Richter hernias occur in people older than 60. This may be because our tissues weaken with age, making gaps more likely. A history of laparoscopic or robotic surgery is another risk factor. While Richter hernias aren’t common, they’ve become more common with the rise of minimally invasive surgery.

Complications of Richter hernia

Richter hernias are more likely than others to become incarcerated and strangulated. This is very serious. When part of your bowel loses its blood supply, the tissue starts to die. This can lead to gangrene and infection. It can also produce a hole in your bowel wall. A hole could lead to:

• An abscess or fistula
• Septicemia and sepsis

How doctors diagnose Richter hernias

Because Richter hernias are rare and may not cause obvious symptoms, they can be hard to recognize right away. Your healthcare provider will take steps to find the cause of your symptoms. Imaging tests are most likely to find it. A Richter hernia may show up on an ultrasound, but a CT scan is better.

Your provider may also see signs of the problem on blood tests. A high white blood cell count could suggest an infection or tissue damage. Other signs may appear if you have severe complications. If your test results suggest an emergency, you may have additional imaging tests or even exploratory surgery.

How is a Richter hernia treated?

A Richter hernia needs surgery, and often, quickly. By the time your provider discovers it, the hernia may already be strangulated. This is an emergency and usually requires open surgery (laparotomy). If it’s not strangulated, you can have elective hernia repair surgery. This is usually a minimally invasive procedure.

Treatment for complications

Strangulated Richter hernias progress to gangrene faster than others. One study found the rate was close to 70%. So, many people with Richter hernias will need treatment for gangrene and infection. This means your surgeon will have to remove the dead tissue from your bowel and sterilize the area.

You might need:

• IV fluids and antibiotics to prevent or treat infection
• Bowel resection surgery to remove the dead part of your bowel
• A temporary ostomy

Bowel resection surgery is different from a hernia repair surgery. Hernia repair just means moving the herniated tissue back into place and closing the hole it came through. But if you have dead tissue, your surgeon will have to cut that part of your bowel out. This means you’ll have stitches in your bowel.

While your bowel heals, you may need to keep poop away from the wound. This means your surgeon may need to create another way for your poop to come out. Your surgeon will divert the healthy part of your bowel to a new opening in your abdomen (ostomy). They can reverse this after you’ve healed.

Recovery time

A simple hernia repair has a simple recovery. You’ll be back to your routine within a few days. But bowel resection is a major surgery. You’ll spend at least a few days in the hospital and six weeks after that recovering at home. You and your surgeon may discuss an ostomy reversal after your recovery.

When should I see my healthcare provider for a Richter hernia?

If you’ve had abdominal surgery, look out for hernia symptoms. If they develop, contact your healthcare provider right away. Early recognition and treatment lead to the best outcomes for Richter hernias. If you’re recovering from a Richter hernia, contact your provider if you develop new symptoms.

What can I expect if I have a Richter hernia?

A Richter hernia is often an emergency by the time a provider discovers it. In this case, you’ll need a bowel resection and possibly a temporary ostomy. Full recovery may take many months. But if your hernia isn’t strangulated, you can expect a simple surgical repair with a much shorter recovery.