Describe Maydl's & Littre's Hernia in detail.

The Concept — Two Named Hernias

Maydl's and Littre's hernias are two eponymous hernias defined by their unusual contents, and both are favourite viva topics because of the traps they set.

Maydl's Hernia (hernia-in-w)

A Maydl's hernia is a 'W'-shaped double-loop hernia: two loops of bowel lie within the sac, connected by a central loop that lies back inside the abdominal cavity. The danger is that the strangulation affects this connecting central loop — which is inside the abdomen, not in the visible sac. So the loops in the sac may look healthy while the intra-abdominal loop is gangrenous ('retrograde strangulation'). The lesson is that at operation for a strangulated hernia, the bowel inside the abdomen must also be inspected, not just the contents of the sac.

Littre's Hernia

A Littre's hernia is a hernia whose sac contains a Meckel's diverticulum. Because a Meckel's diverticulum can become inflamed or strangulated within the hernia, it may present with local features of strangulation, and, as with a Richter's hernia, may not cause complete intestinal obstruction. It is managed by surgical exploration with resection of the diverticulum and repair of the hernia.

The Teaching Point of Each

Each hernia carries a distinct teaching point. Maydl's warns that the sac contents can look healthy while the real damage is in a loop hidden inside the abdomen, so the intra-abdominal bowel must always be checked at operation for a strangulated hernia. Littre's warns that a hernia can contain a Meckel's diverticulum which may strangulate or inflame without full obstruction. Both reinforce the general rule that a tender irreducible hernia demands exploration regardless of whether obstruction is present.

The Bottom Line

Maydl's (W-loop with the strangulated loop inside the abdomen) and Littre's (Meckel's-containing) hernias both teach that a tender irreducible hernia needs exploration and inspection of all the bowel, sac and intra-abdominal.

A Note on Retrograde Strangulation

The term retrograde (or 'W') strangulation used for Maydl's hernia captures the paradox neatly: the loops you can see and feel in the sac may be perfectly healthy, while the connecting loop that has slipped back into the abdomen is the one being strangled. The operative discipline it teaches — to deliver and inspect the intervening intra-abdominal bowel — is the whole point of the eponym.

In Maydl hernia the ischaemic loop lies inside the abdomen, not the sac.

• Maydl's hernia = 'W'-loop: two loops in the sac with a connecting central loop inside the abdomen; the intra-abdominal loop strangulates ('retrograde strangulation').
• Lesson: inspect the intra-abdominal bowel too — the sac contents may look viable while the hidden loop is gangrenous.
• Littre's hernia = a hernia sac containing a Meckel's diverticulum (may strangulate without complete obstruction).
• Both managed by surgical exploration, resection of non-viable bowel/diverticulum, and repair.