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Littre’s hernia: a systematic review of the literature

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Abstract

Purpose

A hernia containing Meckel’s diverticulum is called a Littre’s Hernia. It’s a rare entity and its diagnosis is often incidental during routine hernia repair surgery. The objective of this study is the evaluation of the current evidence on Littre’s hernias regarding their clinical presentation and optimal treatment approach.

Methods

PubMed and Cochrane bibliographical databases were searched from the beginning of time (last search: August 1st, 2018) for studies reporting on Littre’s hernias in adult population.

Results

Forty-five studies met our inclusion criteria and reported collectively on 53 patients (21 males and 32 females) presenting at health care units with a Littre’s hernia. The most common sites of occurrence were femoral (39.6%) and inguinal (34%). The vast majority of cases (77.4%) concerned incarcerated hernias. All patients underwent surgical hernia repair accompanied by a diverticulectomy and 16.9% of them received mesh. Only 7.5% of patients experienced immediate postoperative complications.

Conclusions

A Littre hernia is a rare complication of Meckel’s diverticulum. It requires surgical attention and all medical professionals should be encouraged to report such cases to expand our experience and optimize the therapeutic approach.

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References

  1. Sagar J, Kumar V, Shah DK (2006) Meckel’s diverticulum: a systematic review. J R Soc Med 99(10):501–505. https://doi.org/10.1258/jrsm.99.10.501

    Article  PubMed  PubMed Central  Google Scholar 

  2. Opitz JM, Schultka R, Gobbel L (2006) Meckel on developmental pathology. Am J Med Genet Part A 140(2):115–128. https://doi.org/10.1002/ajmg.a.31043

    Article  PubMed  Google Scholar 

  3. Kanazawa K, Ishikawa K, Shoji R, Okamoto A (1972) Littre’s femoral hernia causing intestinal fistula. Jpn J Surg 2(1):37–46

    Article  PubMed  CAS  Google Scholar 

  4. Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P (2006) Littre hernia: surgical anatomy, embryology, and technique of repair. Am Surg 72(3):238–243

    PubMed  Google Scholar 

  5. Matsagas MI, Fatouros M, Koulouras B, Giannoukas AD (1995) Incidence, complications, and management of Meckel’s diverticulum. Arch Surg (Chicago, Ill: 1960) 130(2):143–146

    Article  CAS  Google Scholar 

  6. Levy AD, Hobbs CM (2004) From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic correlation. Radiogr Rev Publ Radiol Soc N Am Inc 24(2):565–587. https://doi.org/10.1148/rg.242035187

    Article  Google Scholar 

  7. Yagmur Y, Akbulut S, Can MA (2014) Gastrointestinal perforation due to incarcerated Meckel’s diverticulum in right femoral canal. World J Clin Cases WJCC 2(6):232–234. https://doi.org/10.12998/wjcc.v2.i6.232

    Article  PubMed  Google Scholar 

  8. Horkoff MJ, Smyth NGC, Hunter JM (2014) A large incarcerated Meckel’s diverticulum in an inguinal hernia. Int J Surg Case Rep 5(12):899–901. https://doi.org/10.1016/j.ijscr.2014.09.036

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brown CK, Olshaker JS (1988) Meckel’s diverticulum. Am J Emerg Med 6(2):157–164

    Article  PubMed  CAS  Google Scholar 

  10. Andrew DR, Williamson KM (1994) Meckel’s diverticulum-rare complications and review of the literature. J R Army Med Corps 140(3):143–145

    Article  PubMed  CAS  Google Scholar 

  11. Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR (2005) Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950–2002). Ann Surg 241(3):529–533. https://doi.org/10.1097/01.sla.0000154270.14308.5f

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bailon-Cuadrado M, Rodriguez-Lopez M, Blanco-Alvarez JI, Rodriguez-Vielba PL (2016) Incarcerated umbilical Littre’s hernia at the trocar site of a previous laparoscopic surgical procedure. Ann R Coll Surg Engl 98(5):e82–e83. https://doi.org/10.1308/rcsann.2016.0133

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Misiak P, Piskorz Ł, Kutwin L, Jabłoński S, Kordiak J, Brocki M (2014) Strangulation of a Meckel’s diverticulum in a femoral hernia (Littre’s hernia). Przeglad Gastroenterologiczny 9(3):172–174. https://doi.org/10.5114/pg.2014.43580

    Article  PubMed  PubMed Central  Google Scholar 

  14. Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR (2005) Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950–2002). Ann Surg 241(3):529–533

    Article  PubMed  PubMed Central  Google Scholar 

  15. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wallace BC, Small K, Brodley CE, Lau J, Trikalinos TA (2012) Deploying an interactive machine learning system in an evidence-based practice center: abstrackr. In: Paper presented at the proceedings of the 2nd ACM SIGHIT international health informatics symposium, Miami, Florida, USA

  17. Davis CE (1954) Littre’s hernia: report of two cases. Ann Sur 139(3):370–373

    Article  Google Scholar 

  18. Ioannidis A, Karanikas I, Koutserimpas C, Velimezis G (2018) Combined Littre and Richter’s femoral hernia: an extremely rare intra-operative finding. Il Giornale di chirurgia 39(3):177–180

    PubMed  CAS  Google Scholar 

  19. Arif A, Abideen ZU, Zia N, Khan MA (2015) Perforated obturator Littre hernia in an elderly woman. Ann Saudi Med 35(4):324–326. https://doi.org/10.5144/0256-4947.2015.324

    Article  PubMed  PubMed Central  Google Scholar 

  20. Racy M, Ramesh S (2013) Littré meets de garengeot: meckel’s diverticulum and appendix in a femoral hernia. Ann R Coll Surg Engl 95(6):e97–e98. https://doi.org/10.1308/003588413X13629960047399

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Baum RK, Olch IY (1958) Meckel’s diverticulum incarcerated in a femoral hernia. Calif Med 88(5):386–388

    PubMed  PubMed Central  CAS  Google Scholar 

  22. Balani A, Marda SS, Alwala S, Reddy SP, Kumar AD, Devu S (2015) Perforated Littre’s hernia diagnosed on imaging: case report and review of literature. Jpn J Radiol 33(6):366–369. https://doi.org/10.1007/s11604-015-0422-5

    Article  PubMed  Google Scholar 

  23. Hakeem AA, Shaheen F, Shafi H, Gojwari TA, Rasool S (2009) CT findings in obturator hernia with Meckel’s diverticulum—a case report. J Gastrointest Surg Off J Soc Surg Aliment Tract 13(3):576–577. https://doi.org/10.1007/s11605-007-0436-0

    Article  Google Scholar 

  24. Phillips AW, Aspinall SR (2012) Appendicitis and Meckel’s diverticulum in a femoral hernia: simultaneous De Garengeot and Littre’s hernia. Hernia J Hernias Abdom Wall Surg 16(6):727–729. https://doi.org/10.1007/s10029-011-0812-2

    Article  CAS  Google Scholar 

  25. Malling B, Karlsen AA, Hern J (2017) Littre hernia: a rare case of an incarcerated Meckel’s diverticulum. Ultrasound Int Open 3(2):E91–E92. https://doi.org/10.1055/s-0043-102179

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jay GD III, Margulis RR, Mc GA, Northrip RR (1950) Meckel’s diverticulum; a survey of one hundred and three cases. Arch Surg (Chicago, Ill: 1960) 61(1):158–169

    Article  Google Scholar 

  27. Haber JJ (1947) Meckel’s diverticulum; review of literature and analytical study of 23 cases with particular emphasis on bowel obstruction. Am J Surg 73(4):468–485

    Article  PubMed  CAS  Google Scholar 

  28. Bacalbasa N, Costin R, Orban C, Iliescu L, Hurjui I, Hurjui M, Niculescu N, Cristea M, Balescu I (2016) Incidental finding of a neuroendocrine tumor arising from Meckel diverticulum during hernia repair—a case report and literature review. Anticancer Res 36(4):1861–1864

    PubMed  Google Scholar 

  29. Perlman JA, Hoover HC, Safer PK (1980) Femoral hernia with strangulated Meckel’s diverticulum (Littre’s hernia). Am J Surg 139(2):286–289

    Article  PubMed  CAS  Google Scholar 

  30. Sinha R (2005) Bowel obstruction due to Littre hernia: CT diagnosis. Abdom Imaging 30(6):682–684. https://doi.org/10.1007/s00261-005-0318-4

    Article  PubMed  CAS  Google Scholar 

  31. Payson BA, Schneider KM, Victor MB (1956) Strangulation of a Meckel’s diverticulum in a femoral hernia (Littre’s). Ann Surg 144(2):277–281

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Zeina AR, Mahamid A, Sakran N, Troitsa A (2012) Computed tomographic diagnosis of incarcerated Meckel’s diverticulum in a patient with bilateral spigelian hernia. J Gastrointest Surg Off J Soc Surg Aliment Tract 16(2):447–449. https://doi.org/10.1007/s11605-011-1638-z

    Article  Google Scholar 

  33. Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ (1994) Surgical management of Meckel’s diverticulum. An epidemiologic, population-based study. Ann Surg 220(4):564–569

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Muakkassa FF, Abouchedid C (1987) Littre’s hernia. N J Med J Med Soc N J 84(9):653–655

    CAS  Google Scholar 

  35. Citgez B, Yetkin G, Uludag M, Karakoc S, Akgun I, Ozsahin H (2011) Littre’s hernia, an incarcerated ventral incisional hernia containing a strangulated meckel diverticulum: report of a case. Surg Today 41(4):576–578. https://doi.org/10.1007/s00595-010-4308-y

    Article  PubMed  Google Scholar 

  36. Miele V, De Cicco ML, Andreoli C, Buffa V, Adami L, David V (2001) US and CT findings in complicated Meckel diverticulum. La Radiologia medica 101(4):230–234

    PubMed  CAS  Google Scholar 

  37. Biel A, Vilallonga R, Lopez-de-Cenarruzabeitia I, Rodriguez N, Armengol M (2010) Littre s hernia: unusual find in inguino-scrotal hernial repair. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola. de Patologia Digestiva 102(8):506–507

    CAS  Google Scholar 

  38. Jacob TJ, Gaikwad P, Tirkey AJ, Rajinikanth J, Raj JP, Muthusami JC (2009) Perforated obturator Littre hernia. Can J Surg 52(3):E77–E78

    PubMed  PubMed Central  Google Scholar 

  39. Ingle NG, Hopkins SM (1952) Lateral femoral hernia and strangulated Meckel’s diverticulum. AMA Arch Surg 64(3):401–404

    Article  PubMed  CAS  Google Scholar 

  40. Zacharakis E, Papadopoulos V, Athanasiou T, Ziprin P, Zacharakis E (2008) An unusual presentation of Meckel diverticulum as strangulated femoral hernia. South Med J 101(1):96–98. https://doi.org/10.1097/SMJ.0b013e31815d3c83

    Article  PubMed  Google Scholar 

  41. Mirza MS (2007) Incarcerated Littre’s femoral hernia: case report and review of the literature. J Ayub Med Coll Abbottabad JAMC 19(2):60–61

    PubMed  Google Scholar 

  42. Singh RR, Sinha CK, Joshi A (2014) Littre’s hernia with an impalpable testis in a boy: a diagnostic dilemma. BMJ Case Rep 2014:bcr2014203849. https://doi.org/10.1136/bcr-2014-203849

    Article  PubMed  PubMed Central  Google Scholar 

  43. Salemis NS (2009) Incarceration of Meckel’s diverticulum through a ventral incisional defect: a rare presentation of Littre’s hernia. Hernia J Hernias Abdom Wall Surg 13(4):443–445. https://doi.org/10.1007/s10029-008-0463-0

    Article  CAS  Google Scholar 

  44. Baird J (1998) Strangulated Meckel’s diverticulum. Can J Surg 41(6):422–422

    PubMed  PubMed Central  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 str., Goudi, 15771, Athens, Greece

    D. Schizas, I. Katsaros, A. Michalinos, D. I. Tsilimigras & M. Frountzas

  2. Surgical Department, General Hospital of Ierapetra, Ierapetra, Greece

    D. Tsapralis

  3. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    D. Moris

  4. Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece

    N. Machairas

  5. Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens, Athens, Greece

    T. Troupis

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  1. D. Schizas
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  2. I. Katsaros
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Contributions

Conception and design: DS, NM. Data collection, analysis and interpretation: DS, IK, DT, TT. Writing the manuscript: DS, IK, DT, MF, AM. Critical revision of the manuscript: DS, IK, DM, DIT.

Corresponding author

Correspondence to I. Katsaros.

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Conflict of interest

DS declares no conflict of interest. IK declares no conflict of interest. DT declares no conflict of interest. DM declares no conflict of interest. AM declares no conflict of interest. DIT declares no conflict of interest. MF declares no conflict of interest. NM declares no conflict of interest. TT declares no conflict of interest.

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Approval from the institutional review board was not required for this type of study.

Human and animal rights

This article is a systematic review and it contains data collected through literature review. It does not include research directly involving human or animal participation.

Informed consent

For this systematic review, informed consent was not necessary.

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Schizas, D., Katsaros, I., Tsapralis, D. et al. Littre’s hernia: a systematic review of the literature. Hernia 23, 125–130 (2019). https://doi.org/10.1007/s10029-018-1867-0

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  • DOI: https://doi.org/10.1007/s10029-018-1867-0

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