A Case of Small Bowel Obstruction due to a Richter Inguinal Hernia and Enterolith

Abstract

We report a rare case of small bowel obstruction due to a Richter inguinal hernia and enterolith. A 71 year -old man with no history of abdominal surgery admitted for preshock, abdominal pain, and vomiting evidenced slight tenderness in the upper abdomen but neither muscular defense nor the sign of Blumberg. Abdominal computed tomography (CT) showed the small intestine to be dilated, leading us to suspect an inguinal hernia. Abdominal ultrasonography (US) showed part of the ileal incarcerated in the inguinal hernia orifice and an enterolith with an acoustic shadow. Based on a diagnosis of small bowel obstruction due to a Richter inguinal hernia and enterolith, we conducted emergency surgery. On laparotomy, we released the strangulated hernia and found that a small part of the ileal wall 40 cm oral from the ileum evidenced ischemic change and confirmed the presence of a hard 4 cm enterolith, so we partially resected the ileum and repaired the inguinal hernia. The solidly spongy enterolith was 5×3cm.