A Case Report of Necrotizing Fasciitis in Right Thigh due to Perforation of the Small Intestine by Incarcerated Right Femoral Hernia

A 75-year-old woman who complained abdominal pain and vomiting and had no previous laparotomy was diagnosed as having ileus. A long tube was placed to decompress of the intestine. After symptoms were disappeared, she began oral intake. After that she had a fever, right hip joint pain, and swelling of the right femoral area. She received an incision in that area because of the phlegmon. Then, a continuous fecal discharge was observed from this incision. Fistulography showed a fecal fistula connected to the small bowel through the femoral cananl. Therefore we made a diagnosis of perforation of small intestine by incarcerated femoral hernia caused necrotizing fasciitis of the right thigh. At the operation, the incarcerated part of the ileum wall was necrosed and perforated into the femoral canal. Partial resection of the ileum and debridement of the right thigh were performed. Nineteen days after the operation, skin plantation was done. No complications occurred postoperatively. Diagnosis of Richter hernia is likely to be late, since there are often no marked local findings. This suggests that Richter's hernia should be considered in a case of intestinal obstruction without previous laparotomy.