Necrotizing Fasciitis Arising from An Enterolabial Fistula: A Rare Sequela of Neglected Richter’s Hernia – Case Report

Abstract

Background: Richter’s hernias are clinically distinctive due to their potential to cause bowel strangulation without overt intestinal obstruction. Conversely, they may occasionally present obstructive symptoms in the absence of strangulation, further complicating diagnosis. Necrotizing fasciitis is a rapidly progressive, polymicrobial infection characterized by extensive tissue necrosis and systemic toxicity, often resulting in severe morbidity or mortality if not promptly and aggressively managed. The study aimed to report a rare case of neglected Richter’s hernia complicated by necrotizing fasciitis secondary to an enterolabial fistula, and to emphasize the importance of early recognition and prompt surgical intervention.

Case Summary: We present a sixty-year-old woman with a 20-year history of neglected groin swelling, which became irreducible 3 weeks prior to presentation and started discharging. The evolution of a Richter hernia from strangulation to obstruction, culminating in perforation and enterolabial fistula formation, was noted. She had an exploratory laparotomy and segmental small bowel resection with primary anastomosis; the labial wound was explored, debrided, and serially dressed.

Conclusion and Recommendations: Neglected Richter’s hernias can result in rare life-threatening complications, such as enterolabial fistula and necrotizing fasciitis. Early surgical evaluation and treatment of irreducible hernias is vital to prevent such sequelae.