Strangulated Richter's femoral hernia presenting as an enterocutaneous fistula

Femoral hernias are elusive conditions that despite having life-threatening complications are often misdiagnosed or underdiagnosed in asymptomatic patients. Anatomically they represent herniation of the peritoneal sac through the femoral ring into the femoral canal. A Richter's hernia is one in which only a part of the circumference of the bowel is entrapped in the hernia orifice often leading to ischaemia, gangrene and perforation of the bowel. When less than two-thirds of the circumference of the bowel wall is involved, the signs and symptoms of intestinal obstruction are absent. This leads to late diagnosis or even misdiagnosis leading to bowel necrosis. However, a spontaneous faecal fistula is a rare complication in a long standing abdominal wall hernia. In view of its rarity, a case of spontaneous faecal fistula secondary to strangulated Richter's femoral hernia is reported.