EP 223 Management of a Mixed Littre Hernia
Clare BartholomewAbstract
Introduction
A hernia containing a Meckel’s diverticulum is termed a Littre hernia, with the mixed subtype describing the presence of additional abdominal viscera. Mixed Littre hernias are rare and often identified intra-operatively. Management remains controversial, divided between conservative management, selective resection and routine prophylactic resection.
Case Presentation
We report the case of a 62-year-old man with ischaemic heart disease, hypercholesterolaemia and pre-diabetes undergoing an elective right inguinoscrotal hernia repair. Intra-operatively a loop of ileum with a 10cm Meckel’s diverticulum was identified within the hernia sac. The diverticulum appeared normal and was managed conservatively with no complications at six months.
Clinical Discussion
Conservative management avoids additional operative risk and is supported by low complication rates from asymptomatic Meckel’s diverticula. Selective resection is advocated when risk factors are present – age <50 years, male sex, diverticulum length >2cm or abnormal appearance – each increasing the likelihood of developing complications. Routine prophylactic resection is backed by studies reporting low morbidity and negligible mortality from diverticulectomy or small bowel resection. High quality evidence is limited and most studies are retrospective, combine paediatric and adult populations, and provide little long-term follow up. Existing studies focus on intra-abdominal Meckel’s diverticula rather than those in hernia sacs, which may have a distinct risk profile. No guidelines exist from surgical societies.
Conclusion
Management of an incidental Meckel’s diverticulum, whether intra-abdominal or within a hernia sac, remains debatable. Further research and development of evidence-based guidelines are required to support decision making in rare cases, such as a mixed Littre hernia.