Littré's hernia within a recurrent inguinal hernia sac: an unusual cause of acute abdomen in the elderly-a case report.

Littré's hernia is defined as the protrusion of a Meckel's diverticulum through a hernia defect; it represents fewer than 0.1% of complicated hernias, and its presentation as a recurrent hernia in the elderly is exceptional. We report an 81-year-old man with a previous open right inguinal herniorrhaphy who presented with abdominal pain, vomiting, and a non-reducible right inguinal mass consistent with intestinal obstruction. Exploratory laparotomy revealed a strangulated recurrent right inguinal hernia Nyhus IVB/European Hernia Society (EHS) L3R (lateral inguinal hernia, size 3 [>3 cm], recurrent), containing a 10-cm Meckel's diverticulum located 80 cm from the ileocaecal valve, together with adjacent ileal involvement (mixed Littré's hernia). Segmental small-bowel resection with side-to-side stapled anastomosis and primary tissue repair without mesh were performed. The patient was discharged on postoperative Day 4 and recovered uneventfully. Early intraoperative recognition and individualised surgical management are essential when contamination contraindicates prosthetic reinforcement.