Littre's Hernia: Case Report of a Lateral Incisional Hernia Containing a Perforated Meckel's Diverticulum

ABSTRACT Littre's hernia, defined as the presence of a Meckel's diverticulum within a hernia sac, is rare and exceptionally uncommon in incisional hernias. Optimal management in emergency settings remains unclear, particularly when definitive abdominal wall reconstruction is considered. A 77‐year‐old man presented with a history of right‐sided abdominal pain and fever. Physical examination revealed a tender incisional hernia at the site of a previous McBurney's incision. Laboratory tests showed elevated inflammatory markers. Computed tomography demonstrated a complicated lateral incisional hernia with a 7‐cm defect and a 3‐cm abscess adjacent to an ileal loop. Emergency surgery via midline laparotomy was performed. Intraoperatively, a perforated Meckel's diverticulum within the hernia sac confirmed a Littre's hernia. A small bowel resection and anastomosis were carried out, followed by reconstruction using a retromuscular Rives repair with transversus abdominis release (TAR) and placement of a 30 × 30 cm polypropylene mesh. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. After 2 years of follow‐up, there was no hernia recurrence or chronic pain, and patient satisfaction was high. This case highlights that, in selected emergency settings, definitive abdominal wall reconstruction using a Rives–TAR approach can be safely performed with favorable long‐term outcomes.