PAEA Surgery End Of Rotation (EOR) Practice Exam

What complication is associated with a Richter hernia?

1. Complete bowel obstruction

2. Strangulation of the bowel

3. Gangrenous necrosis

4. Perforation of the bowel

The correct answer is: Gangrenous necrosis

A Richter hernia occurs when only a part of the circumference of the bowel wall is incarcerated or trapped in the hernial sac, which can lead to specific complications. The most significant risk associated with a Richter hernia is gangrenous necrosis of the bowel segment that is trapped. This happens because the hernia restricts blood flow to the involved portion of the bowel, resulting in ischemia and subsequent necrosis. In contrast, complete bowel obstruction may or may not occur because the bowel may still have some degree of patency. While strangulation can be a concern with many types of hernias, in a Richter hernia, it usually refers to the specific trapped segment rather than the entire bowel becoming compromised. Perforation is a serious complication that could ensue after necrosis, but it is not the primary complication associated with Richter hernias themselves. Instead, the direct and immediate threat posed by Richter hernias is indeed gangrenous necrosis due to the compromised blood supply to the affected bowel segment. This understanding underscores the critical nature of monitoring and addressing Richter hernias to prevent severe outcomes.