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

## TL;DR

This case report describes a rare surgical case involving an intestinal-cutaneous fistula caused by a Richter’s femoral hernia in an elderly patient.

## Contribution

The novelty lies in the rare presentation of an intestinal-cutaneous fistula due to an incarcerated Richter’s femoral hernia and its successful surgical management.

## Key findings

- An 81-year-old male with a Richter’s femoral hernia developed an intestinal-cutaneous fistula confirmed by CT imaging.
- Surgical intervention via an intraperitoneal approach successfully resected the affected bowel and closed the hernial orifice.
- The patient recovered well and was discharged after surgery.

## Abstract

Richter’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.

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.

Prompt 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.