Management of Strangulated Richter’s Hernia in a Resource-Limited Setting: Report of Two Cases and Literature Review

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It occurs when the anti-mesenteric border of the bowel is partially trapped in a tight hernial ring. The femoral ring is the most common site, with the ileum being the most frequently involved intestinal segment. However, the advent of laparoscopic surgery has introduced another potential site for Richter’s hernia formation. In our region, this pathological entity is exceptionally diagnosed due to limited access to abdominal imaging and delayed management. Additionally, the wide variety of clinical manifestations resulting from incomplete intestinal obstruction makes it particularly difficult to diagnose. Consequently, it is usually identified during surgery. We present here the case of two adult patients (a 33-yeairs-old woman and a 59-year-old man), the first with a history of surgical procedures and the second with a spontaneously reducible painless inguinal swelling. They were transferred to the surgical emergency department for an acute abdomen with abdominal distension and cessation of matter and gas. Clinical and paraclinical examinations (including hydroaeric level on abdominal X-ray) indicated mechanical intestinal obstruction. Emergency laparotomy, necessitated by the unavailability of abdominal computed tomography due to financial constraints, confirmed the diagnosis of Richter's hernia, with the first case located in the right inguinal region and the second in the linea alba. Surgical management involved reduction of the hernia contents and suture repair in both cases. Despite requiring bowel resection in the second patient, the postoperative course was straightforward. These two rare cases highlight that emergency exploratory laparotomy is the cornerstone of Richter hernia management in resource-limited conditions." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-702", "name": "Management of Strangulated Richter’s Hernia in a Resource-Limited..." } } ] } Home Browse Management of Strangulated Richter’s Hernia in a Resource-Limited... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Boka Tounga Y, Issoufou Hamma O, Zabeirou A et al. Management of Strangulated Richter’s Hernia in a Resource-Limited Setting: Report of Two Cases and Literature Review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :702 ( https://doi.org/10.12688/f1000research.153064.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Clinical Practice Article Management of Strangulated Richter’s Hernia in a Resource-Limited Setting: Report of Two Cases and Literature Review [version 1; peer review: 1 approved, 1 approved with reservations] Yahouza Boka Tounga 1 , Ousmane Issoufou Hamma https://orcid.org/0009-0007-2037-1350 2 , Aliou Zabeirou 3 , Kadi Ide 1 , Rachid Sani 1,4 Yahouza Boka Tounga 1 , Ousmane Issoufou Hamma https://orcid.org/0009-0007-2037-1350 2 , [...] Aliou Zabeirou 3 , Kadi Ide 1 , Rachid Sani 1,4 PUBLISHED 27 Jun 2024 Author details Author details 1 Department of Surgery, National Hospital of Niamey, Niamey, Niger 2 Department of Neurosurgery, National Hospital of Niamey, Niamey, Niger 3 Department of Surgery, National Hospital of Reference, Niamey, Niger 4 Department of Surgery and Surgical Specialties, Faculty of Health Sciences of Abdou Moumouni University, Niamey, Niger Yahouza Boka Tounga Roles: Conceptualization, Data Curation, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ousmane Issoufou Hamma Roles: Conceptualization, Data Curation, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Aliou Zabeirou Roles: Conceptualization, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Kadi Ide Roles: Conceptualization, Data Curation, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Rachid Sani Roles: Conceptualization, Data Curation, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Richter’s hernia is a rare type of abdominal wall hernia characterized by high morbidity and mortality. It occurs when the anti-mesenteric border of the bowel is partially trapped in a tight hernial ring. The femoral ring is the most common site, with the ileum being the most frequently involved intestinal segment. However, the advent of laparoscopic surgery has introduced another potential site for Richter’s hernia formation. In our region, this pathological entity is exceptionally diagnosed due to limited access to abdominal imaging and delayed management. Additionally, the wide variety of clinical manifestations resulting from incomplete intestinal obstruction makes it particularly difficult to diagnose. Consequently, it is usually identified during surgery. We present here the case of two adult patients (a 33-yeairs-old woman and a 59-year-old man), the first with a history of surgical procedures and the second with a spontaneously reducible painless inguinal swelling. They were transferred to the surgical emergency department for an acute abdomen with abdominal distension and cessation of matter and gas. Clinical and paraclinical examinations (including hydroaeric level on abdominal X-ray) indicated mechanical intestinal obstruction. Emergency laparotomy, necessitated by the unavailability of abdominal computed tomography due to financial constraints, confirmed the diagnosis of Richter's hernia, with the first case located in the right inguinal region and the second in the linea alba. Surgical management involved reduction of the hernia contents and suture repair in both cases. Despite requiring bowel resection in the second patient, the postoperative course was straightforward. These two rare cases highlight that emergency exploratory laparotomy is the cornerstone of Richter hernia management in resource-limited conditions. READ ALL READ LESS Keywords Abdominal hernia, inguinal hernia, Richter’s hernia, emergency surgery performed, developing countries, case report Corresponding Author(s) Ousmane Issoufou Hamma ( [email protected] ) Close Corresponding author: Ousmane Issoufou Hamma Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Boka Tounga Y et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Boka Tounga Y, Issoufou Hamma O, Zabeirou A et al. Management of Strangulated Richter’s Hernia in a Resource-Limited Setting: Report of Two Cases and Literature Review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :702 ( https://doi.org/10.12688/f1000research.153064.1 ) First published: 27 Jun 2024, 13 :702 ( https://doi.org/10.12688/f1000research.153064.1 ) Latest published: 27 Jun 2024, 13 :702 ( https://doi.org/10.12688/f1000research.153064.1 ) Introduction Richter’s hernia is a rarely encountered surgical entity. It is defined as the protrusion and/or strangulation of only part of the circumference of the intestine’s anti-mesenteric border through the hernia orifice, leading to a risk of ischemia, gangrenous bowel, and perforation. 1 – 4 The most common location of this pathology is the femoral canal (36-88%), followed by the inguinal canal (12-36%) and incisional hernia of the abdominal wall (4-25%). 3 – 5 The increase in laparoscopic and robotic surgery has contributed to the rise in Richter-type hernias at trocar sites. 6 Diagnosis of this pathology is challenging in our region due to long admission times, limited availability of abdominal imaging, and varied clinical presentations. The management of Richter's hernia depends on the viability of the incarcerated intestine, which must be assessed; intestinal resection is indicated in the event of necrosis. 5 , 7 We report two rare cases of Richter's hernia found during emergency exploratory laparotomy; with the first case located in the right inguinal region and the second in the linea alba. Post-operative management was straightforward in both patients, although bowel resection was necessary in the second. These cases highlight the important role of emergency exploratory laparotomy. This case report has been reported in line with the SCARE Criteria. 8 Case report Case 1 A 33-year-old married woman with an obstetrical history of three births, two parities, one abortion, and two cesarean sections (the most recent about four weeks prior) was transferred to the surgical emergency department for rapidly progressive diffuse abdominal pain associated with vomiting and cessation of matter and gas lasting four days. Clinical examination revealed an overweight, afebrile patient with a core temperature of 36.5-37°C. The patient was hemodynamically and respiratory stable with a blood pressure of 130/67 mmHg, pulse rate of 108 beats/min, and respiratory rate of 24 breaths/min, and blood oxygen saturation was 96% on ambient air. Abdominal examination revealed a distended abdomen, and tympany on the percussion, with an old Pfannenstiel-type surgical scar. The examinations of cardiovascular, gynecology, neurology, and pelvic touch were without peculiarities. Following this clinical examination, mechanical intestinal obstruction was suspected. Abdominal X-ray showed signs of small bowel obstruction in the form of distension and hydroaeric levels with a large dilated loop image ( Figure 1 ). Abdominal computed tomography (CT) scan was not performed due to financial constraints; however, other biological tests were normal. The patient was resuscitated with intravenous crystalloid fluids and received intravenous analgesia (Paracetamol 5g/24h, tramadol hydrochloride 300mg/24h) and antibiotic prophylaxis (ceftriaxone 2g/24h). The patient was admitted to the operating room for emergency median laparotomy under general anesthesia in the supine position. Surgical exploration revealed a strangulated loop at the linea alba, located on the anti-mesenteric face of the ileum, 80 cm from the ileocecal valve ( Figure 2 ). The diagnosis of Richter's hernia of the linea alba was confirmed. The incarcerated loop was viable. We proceeded with disincarceration and reintegration of the contents of the hernia, followed by resection of the hernia sac and suture repair of the hernia. The postoperative course was straightforward; antibiotic prophylaxis was discontinued after 96 hours, and early ambulation was recommended. The patient was discharged after seven days of hospitalization and was advised to avoid heavy lifting for 3 months. After six months of follow-up, there was no sign of recurrence, and the patient resumed her daily activities. Figure 1. Plain X-ray of the abdomen showing distension and hydroaeric levels (red arrows). Figure 2. Intraoperative view of the hernia sac contents after laparotomy. Damaged loop on its antimesenteric edge (blue arrow), distension of its proximal part (yellow arrow), and distal flattening (purplish arrow). Case 2 A 59-year-old married man with a history of painless, spontaneously reducible right inguinal swelling, cough impulse, and chronic constipation for two years; was transferred to the emergency department with a right inguinal swelling that had become very painful, firm, non-reducible, and without cough impulse, which had been evolving for around 72-96 hours. The clinical picture worsened approximately 8-9 hours before admission, with the onset of abdominal distension, vomiting, and cessation of matter and gas. Clinical examination showed the patient to be agitated but without any alteration in consciousness. He was hemodynamically and respiratory stable with a blood pressure of 110/65 mmHg, pulse rate of 120 beats/min, and respiratory rate of 23 breaths/min, and his blood oxygen saturation 98% on ambient air. His core temperature was 37-37.5°C, and his body mass index (BMI) was normal at 23 kg/m 2 . The right inguinal swelling remained painful, non-reducible, and without cough impulse ( Figure 3 ), but the rest of the abdomen was soft and painless to palpation. Biological examination revealed an inflammatory process characterized by neutrophilic leukocytosis of 14,900 cells/μL (reference range: 4,000 – 10,000 cells/μL) and 78.12% neutrophils (reference range: 50-70%), along with an increase in C-reactive protein (CRP) levels to 78 mg/L (reference range: < 6 mg/L). However, renal function tests were normal, and there were no ionic or coagulation disorders. A diagnosis of strangulated right inguinal hernia was suspected, but the patient did not undergo abdominal imaging due to financial constraints. The patient was resuscitated with intravenous crystalloid fluids and received in intravenous, an analgesia (paracetamol 5g/24h, tramadol hydrochloride 300mg/24h) and antibiotic prophylaxis (ceftriaxone 2g/24h, metronidazole 1500mg/24h). The patient was then taken to the operating room for an emergency exploratory laparotomy. An elective oblique right kelotomy was performed under general anesthesia in supine position. Intra-operatively, the loop of the ileum was partially incarcerated on its anti-mesenteric border, 35 and 45 cm from the ileocecal junction, resulting in necrosis of the bowel ( Figure 4 ). The diagnosis of Richter's hernia was confirmed, and elective oblique kelotomy was converted to median laparotomy. The necrotic segment of the ileum was segmentally resected, followed by an end-to-end ileo-ileal anastomosis. Finally, primary repair of the hernia was performed. The postoperative course was favorable; antibiotic prophylaxis and intravenous crystalloids were discontinued after 96 hours, and early ambulation was recommended. Digestive transit resumed 72 hours after surgery, and the patient was discharged on the ninth day. He was advised to avoid heavy lifting for 3 months. After six months of ambulatory follow-up, the patient showed no signs of hernia recurrence, despite resuming normal activities. Figure 3. Preoperative view of strangulated right inguinal swelling. Figure 4. Intraoperative view of hernia pouch contents. Discussion Richter’s hernia is defined as a rare hernia of the abdominal wall in which a portion of the circumference of the intestinal tract is trapped and strangulated at the hernial orifice. 2 , 3 , 5 In 1558, Fabricius Hildanus was the first to report a case of Richter's hernia. However, it was not until 1778 that the German surgeon August Gottlieb Richter provided a scientific description of this surgical entity, which would later take the name “Richter’s hernia”. 4 , 7 , 9 , 10 These two cases of Richter hernia are the first to be documented and reported in our region. In the scientific literature, this hernia is most often diagnosed in patients aged between 60 and 80 years and accounts for up to 10% of all strangulated hernias. 2 , 3 , 7 , 11 The average age of our patients was 46 years (33 and 59 years). The clinical picture depends on the location of the hernia. However, it remains exceptional in our region due to difficult access to abdominal imaging and long admission times to the operating theatre. In our cases, abdominal CT scans were not performed due to financial constraints, so an exploratory laparotomy was performed. We confirmed the diagnoses intraoperatively, consistent with the findings reported by most authors. It is important to note that these hernias can occur on anterior incisions but are more frequently observed in small hernial rings large enough to entrap a small portion of the bowel wall. Both our patients developed a hernia at the natural orifice. The most frequent locations were femoral hernias (72-88%), followed by the inguinal canal (12-24%) and umbilical and linea alba hernias (4-25%). 1 , 2 , 4 The clinical presentation of Richter's hernia is highly varied; one of our patients presented with a typical occlusive syndrome, whereas the other had an atypical clinical picture. Because patients rarely present with obstructive symptoms, they tend to progress more rapidly to gangrene than other types of strangulated hernia. Repair is usually approached via the preperitoneal route, with mandatory laparotomy and bowel resection in cases of gangrene or perforation. The silent nature of this hernia presentation and the fact that the patient continues to emit flatulence and stools make it particularly dangerous. At the time of presentation, there is usually ischemia of the affected bowel, and bowel resection is mandatory. 1 , 3 , 4 , 5 , 11 , 13 The necrotic bowel is not the only worrying aspect of these hernias. Other complications described in the literature include spontaneous fistulas from the affected bowel and skin necrosis. Atypical presentations of Richter's hernias have also been reported, such as complications from colonoscopy. 3 , 5 There have also been cases of Richter's hernia simulating a groin abscess, with the diagnosis only being made during laparotomy or the drainage of inguinal abscesses revealing amylaceous material. 14 These examples highlight the diverse clinical presentation of this pathology. Despite the small size of our study population, we recommend rapid surgical intervention (emergency exploratory laparotomy) in patients presenting suspicious clinical signs in resource-limited environments. This approach can lead to an uneventful recovery. However, more studies are needed to establish a guideline for this pathology in resource-limited settings. Conclusion Richter hernia is a rare surgical entity with very high mortality and morbidity. However, this condition has rarely been reported in our region due to limited access to abdominal imaging, long management delays, and varied clinical manifestations. Despite these challenges, our patients achieved favorable operative outcomes, contrary to what is often reported in the literature. Therefore, the management of this pathology in resource-limited settings must be centered on emergency exploratory laparotomy in patients presenting with suspicious clinical signs. Consent Written informed consent for publication of the clinical details and clinical images was obtained from the patient. Checklists and flow charts Figshare: CARE checklist for ‘Scare 2020 Checklist Article Richter Hernia HNN’. 15 https://doi.org/10.6084/m9.figshare.26027293.v1 Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC PAR 4.0 Public domain dedication). Authors’ contributions Conceptualization : YBT, OIH, AZ, KI, RS; Data Curation: YBT, OIH, KI, RS; Project Administration: RS; Resources: YBT, RS; Supervision: RS; Validation: YBT, OIH, AZ, KI, RS; Visualization: YBT, OIH, AZ, KI, RS; Writing – Original Draft Preparation : YBT, OIH, AZ, KI, RS; Writing – Review & Editing : YBT, OIH, AZ, KI, RS Data availability statement No data are associated with this article. Acknowledgements The authors are grateful to the following teacher-researchers: Pr. ABARCHI Habibou, the late Pr. SANOUSSI Samuila, Pr. CHAIBOU Mamane Sani, Pr. YOUNSA Hama Dr. GARBA Ide, and Dr. SAIDOU Adama for their unconditional support. References 1. Bayeh A, Limenh S: Richter’s Type Recurrent Indirect Inguinal Hernia, an Extremely Rare Occurrence: A Case Report. Open Access Emerg Med OAEM. 2022; 14 : 323–326. Publisher Full Text 2. Birhanu AM, Mohammed SH, Mohammed SM, et al. : Incarcerated Richter’s congenital umbilical hernia in a young male: A case report. Int. J. Surg. Case Rep. 2023; 109 : 108576. Publisher Full Text 3. Foster D, Nagarajan S, Panait L: Richter-type Spigelian hernia: A case report and review of the literature. Int. J. Surg. Case Rep. 2015; 6 : 160–162. Publisher Full Text 4. Khuroo S, Wani AA, Kaur I, et al. : Unusual Richter’s Hernia: Impacted foreign body leading to incarceration and perforation - A rare clinical entity. Int. J. Surg. Case Rep. 2021; 79 : 492–495. Publisher Full Text 5. Yonekura S, Kodama M, Murano S, et al. : Richter’s Type of Incarcerated Obturator Hernia that Presented with a Deep Femoral Abscess: An Autopsy Case Report. Am. J. Case Rep. 2016; 17 : 830–833. Publisher Full Text 6. Tobe T, Yuen K, Yasufuku T, et al. : Laparoscopic port site Richter’s hernia after robot-assisted radical prostatectomy. IJU Case Rep. 2022; 5 : 501–504. Publisher Full Text 7. Ahi KS, Moudgil A, Aggarwal K, et al. : A rare case of spontaneous inguinal faecal fistula as a complication of incarcerated Richter’s hernia with brief review of literature. BMC Surg. 2015; 15 : 67. Publisher Full Text 8. Agha RA, Franchi T, Sohrabi C, et al. : The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines. Int. J. Surg. 2020; 84 : 226–230. Publisher Full Text 9. Parmar VS, Vaghasiya GN, Dave JP: A Rare Case of Richter’s Variety of Obstructed Femoral Hernia in a Male. Indian J. Surg. 2015; 77 : 79–80. Publisher Full Text 10. Skandalakis PN, Zoras O, Skandalakis JE, et al. : Richter Hernia: Surgical Anatomy and Technique of Repair. Am. Surg. 2006; 72 : 180–184. Publisher Full Text 11. Chen W, Liu L, Huang H, et al. : A case report of spontaneous umbilical enterocutaneous fistula resulting from an incarcerated Richter’s hernia, with a brief literature review. BMC Surg. 2017; 17 : 15. Publisher Full Text 12. Rammohan A, Naidu RM: Laparoscopic port site Richter’s hernia – An important lesson learnt. Int. J. Surg. Case Rep. 2011; 2 : 9–11. Publisher Full Text 13. Sahsamanis G, Samaras S, Gkouzis K, et al. : Strangulated Richter’s incisional hernia presenting as an abdominal mass with necrosis of the overlapping skin. A case report and review of the literature. Clin. Case Rep. 2017; 5 : 253–256. Publisher Full Text 14. Hartin CW, Caty MG, Bass KD: Laparoscopy for perforated Richter hernia with incarcerated foreign body. J. Pediatr. Surg. 2011; 46 : 1449–1451. Publisher Full Text 15. Issoufou Hamma O, Boka Tounga Y, Zabeirou A, et al. : Scare 2020 Checklist Article Richter Hernia HNN. figshare. 2024. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 27 Jun 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Surgery, National Hospital of Niamey, Niamey, Niger 2 Department of Neurosurgery, National Hospital of Niamey, Niamey, Niger 3 Department of Surgery, National Hospital of Reference, Niamey, Niger 4 Department of Surgery and Surgical Specialties, Faculty of Health Sciences of Abdou Moumouni University, Niamey, Niger Yahouza Boka Tounga Roles: Conceptualization, Data Curation, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ousmane Issoufou Hamma Roles: Conceptualization, Data Curation, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Aliou Zabeirou Roles: Conceptualization, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Kadi Ide Roles: Conceptualization, Data Curation, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Rachid Sani Roles: Conceptualization, Data Curation, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 27 Jun 2024, 13:702 https://doi.org/10.12688/f1000research.153064.1 Copyright © 2024 Boka Tounga Y et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Boka Tounga Y, Issoufou Hamma O, Zabeirou A et al. Management of Strangulated Richter’s Hernia in a Resource-Limited Setting: Report of Two Cases and Literature Review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :702 ( https://doi.org/10.12688/f1000research.153064.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 27 Jun 2024 Views 0 Cite How to cite this report: Sheth H. Reviewer Report For: Management of Strangulated Richter’s Hernia in a Resource-Limited Setting: Report of Two Cases and Literature Review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :702 ( https://doi.org/10.5256/f1000research.167904.r313967 ) The direct URL for this report is: https://f1000research.com/articles/13-702/v1#referee-response-313967 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 04 Sep 2024 Harsh Sheth , Saifee Hospital, Mumbai, Maharashtra, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.167904.r313967 This article is limited in its scope, yet, it's very well written and explained in detail. That Richter's hernia's are an uncommon entity is evident and its treatment is usually straight forward, a laparotomy in a resource limited setting or ... Continue reading READ ALL This article is limited in its scope, yet, it's very well written and explained in detail. That Richter's hernia's are an uncommon entity is evident and its treatment is usually straight forward, a laparotomy in a resource limited setting or a diagnostic laparoscopy otherwise. This article summarises everything well and is written with a clear flow, which is why I am accepting it. Is the background of the cases’ history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the conclusion balanced and justified on the basis of the findings? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Inguinal hernia, ventral hernia, surgical gastroenterology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Sheth H. Reviewer Report For: Management of Strangulated Richter’s Hernia in a Resource-Limited Setting: Report of Two Cases and Literature Review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :702 ( https://doi.org/10.5256/f1000research.167904.r313967 ) The direct URL for this report is: https://f1000research.com/articles/13-702/v1#referee-response-313967 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Salazar-Rios E. Reviewer Report For: Management of Strangulated Richter’s Hernia in a Resource-Limited Setting: Report of Two Cases and Literature Review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :702 ( https://doi.org/10.5256/f1000research.167904.r301504 ) The direct URL for this report is: https://f1000research.com/articles/13-702/v1#referee-response-301504 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 23 Jul 2024 Enrique Salazar-Rios , Universidad Nacional Autonoma de Mexico Escuela Nacional Preparatoria Plantel 5 Jose Vasconcelos, Mexico City, Mexico City, Mexico Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.167904.r301504 This article is a case report that describes the workup and successful surgical management of two cases of Richter's hernia, with one requiring intestinal resection. This condition is rarely reported in the authors' country of origin due to limited access ... Continue reading READ ALL This article is a case report that describes the workup and successful surgical management of two cases of Richter's hernia, with one requiring intestinal resection. This condition is rarely reported in the authors' country of origin due to limited access to imaging studies, often necessitating emergency laparotomy for diagnosis. The authors conclude that in resource-limited settings, the management of this pathology must focus on prompt surgical intervention. Is the background of the cases’ history and progression described in sufficient detail? The authors do a great job of detailing the patients’ progression and outcomes, as well as the medical history of case 1. However, case 2 lacks any previous medical history. If there is no relevant medical history for case 2, this should be specified. Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Overall, the authors do a good job of providing the details of the physical examination and other diagnostic tests. Specifically, in case 1, the authors state that the patient had a history of two cesarean sections. However, they do not specify whether the hernia identified was at the site of the previous scar or another location in the aponeurosis. This information is relevant in the discussion section where the authors state, "Both our patients developed a hernia at the natural orifice." Please clarify whether the patient presented with a hernia at the previous scar (incisional Richter’s hernia) or at a location with previously healthy aponeurosis. Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? The discussion centers on the need to undergo prompt surgical treatment because of the lack of access to imaging studies. The authors state that the "clinical presentation of Richter's hernia is highly varied," but they do not explain why. Richter's hernias often present with nonspecific symptoms, frequently due to spontaneous reduction. Including this explanation in the article would be beneficial, as the nonspecific nature of the symptoms can lead to delays in diagnosis and treatment. A large portion of the article’s discussion is previously described in the article A Case of Richter Hernia: A Rare Entity (Katragadda K, DeStefano LM, Khan MF. A Case of Richter Hernia: A Rare Entity. ACS Case Reviews in Surgery. 2019;2(3):5-7.). The authors should rewrite this section describing the experiences obtained from addressing their own cases to reduce the possibility of it being classified as plagiarism. Is the conclusion balanced and justified on the basis of the findings? The conclusion accurately addresses the importance of prompt surgical intervention, especially in the setting of resource-limited countries. Is the background of the cases’ history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the conclusion balanced and justified on the basis of the findings? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: General Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Salazar-Rios E. Reviewer Report For: Management of Strangulated Richter’s Hernia in a Resource-Limited Setting: Report of Two Cases and Literature Review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :702 ( https://doi.org/10.5256/f1000research.167904.r301504 ) The direct URL for this report is: https://f1000research.com/articles/13-702/v1#referee-response-301504 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 27 Jun 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 27 Jun 24 read read Enrique Salazar-Rios , Universidad Nacional Autonoma de Mexico Escuela Nacional Preparatoria Plantel 5 Jose Vasconcelos, Mexico City, Mexico Harsh Sheth , Saifee Hospital, Mumbai, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Sheth H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 04 Sep 2024 | for Version 1 Harsh Sheth , Saifee Hospital, Mumbai, Maharashtra, India 0 Views copyright © 2024 Sheth H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This article is limited in its scope, yet, it's very well written and explained in detail. That Richter's hernia's are an uncommon entity is evident and its treatment is usually straight forward, a laparotomy in a resource limited setting or a diagnostic laparoscopy otherwise. This article summarises everything well and is written with a clear flow, which is why I am accepting it. Is the background of the cases’ history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the conclusion balanced and justified on the basis of the findings? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Inguinal hernia, ventral hernia, surgical gastroenterology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Sheth H. Peer Review Report For: Management of Strangulated Richter’s Hernia in a Resource-Limited Setting: Report of Two Cases and Literature Review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :702 ( https://doi.org/10.5256/f1000research.167904.r313967) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-702/v1#referee-response-313967 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Salazar-Rios E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Jul 2024 | for Version 1 Enrique Salazar-Rios , Universidad Nacional Autonoma de Mexico Escuela Nacional Preparatoria Plantel 5 Jose Vasconcelos, Mexico City, Mexico City, Mexico 0 Views copyright © 2024 Salazar-Rios E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This article is a case report that describes the workup and successful surgical management of two cases of Richter's hernia, with one requiring intestinal resection. This condition is rarely reported in the authors' country of origin due to limited access to imaging studies, often necessitating emergency laparotomy for diagnosis. The authors conclude that in resource-limited settings, the management of this pathology must focus on prompt surgical intervention. Is the background of the cases’ history and progression described in sufficient detail? The authors do a great job of detailing the patients’ progression and outcomes, as well as the medical history of case 1. However, case 2 lacks any previous medical history. If there is no relevant medical history for case 2, this should be specified. Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Overall, the authors do a good job of providing the details of the physical examination and other diagnostic tests. Specifically, in case 1, the authors state that the patient had a history of two cesarean sections. However, they do not specify whether the hernia identified was at the site of the previous scar or another location in the aponeurosis. This information is relevant in the discussion section where the authors state, "Both our patients developed a hernia at the natural orifice." Please clarify whether the patient presented with a hernia at the previous scar (incisional Richter’s hernia) or at a location with previously healthy aponeurosis. Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? The discussion centers on the need to undergo prompt surgical treatment because of the lack of access to imaging studies. The authors state that the "clinical presentation of Richter's hernia is highly varied," but they do not explain why. Richter's hernias often present with nonspecific symptoms, frequently due to spontaneous reduction. Including this explanation in the article would be beneficial, as the nonspecific nature of the symptoms can lead to delays in diagnosis and treatment. A large portion of the article’s discussion is previously described in the article A Case of Richter Hernia: A Rare Entity (Katragadda K, DeStefano LM, Khan MF. A Case of Richter Hernia: A Rare Entity. ACS Case Reviews in Surgery. 2019;2(3):5-7.). The authors should rewrite this section describing the experiences obtained from addressing their own cases to reduce the possibility of it being classified as plagiarism. Is the conclusion balanced and justified on the basis of the findings? The conclusion accurately addresses the importance of prompt surgical intervention, especially in the setting of resource-limited countries. Is the background of the cases’ history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the conclusion balanced and justified on the basis of the findings? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise General Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Salazar-Rios E. Peer Review Report For: Management of Strangulated Richter’s Hernia in a Resource-Limited Setting: Report of Two Cases and Literature Review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :702 ( https://doi.org/10.5256/f1000research.167904.r301504) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-702/v1#referee-response-301504 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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