Surgical Management of a Rare Inguinal Intestinal-Cutaneous Fistula with an Incarcerated Richter's Femoral Hernia: A Case Report.

introductionRichter's hernia is a rare type of hernia in which only a part of the intestinal wall becomes entrapped, often leading to ischemia and necrosis. In rare cases, it can result in spontaneous formation of an intestinal-cutaneous fistula. Herein, we report a rare case of an intestinal-cutaneous fistula caused by incarceration of a Richter's femoral hernia. Additionally, we present a brief literature review to highlight the diagnostic and therapeutic challenges associated with this condition. CASE PRESENTATION: An 81-year-old male with severe dementia presented with fecal leakage from the right groin. Physical examination revealed a 5-mm skin defect with stool discharge, and contrast-enhanced CT confirmed a small bowel skin fistula secondary to an incarcerated Richter's femoral hernia. Given the patient's stable condition and absence of peritoneal signs, initial conservative management was chosen. However, surgical intervention was performed because there was no improvement. Due to difficulty in dissection, an intraperitoneal approach was required. The affected bowel was resected, a functional end-to-end anastomosis was performed, and the hernial orifice was closed using a combined approach. The patient recovered uneventfully and was discharged.

conclusionsPrompt recognition and appropriate management are essential to improving outcomes in cases of Richter's hernia complicated by intestinal-cutaneous fistula formation in the aging population.