Littre’s hernia: a case report of a rare intraoperative finding

Abstract

Background: Littre’s hernia (LH) is a rare type of hernia defined by the containment of a Meckel’s diverticulum. The true incidence of LH is unknown and has been mostly reported in the pediatric population, making the finding in adults infrequent and those located at the umbilicus exceedingly rare. Only 9 previous reports have described cases of umbilical LH. LH is largely asymptomatic making the diagnosis of these pre-operatively highly unlikely. Case Description: We report the case of a 59-year-old man who presented for elective repair of an umbilical hernia. An intraoperative diagnosis of a LH was established. The lesion was subsequently repaired through a laparoscopic approach with partial bowel resection due to concerns for potential malignancy. To reduce the risk of infection, the use of mesh was omitted. However, based on low overall reported rates of surgical site infections in LH repair, mesh repair may represent a favorable alternative to primary closure alone. Conclusions: Although exceedingly rare, LH should be included on the differential diagnosis of a newly discovered adherent mass during hernia repair surgery. Treatment options are diverse, and largely depend on operator preference. If the team elects to employ a mesh, recent literature suggests a pre-peritoneal approach is superior to an intra-peritoneal onlay.