A CASE OF OBTURATOR FORMEN HERNIA IN 93 YEAR OLD DIAGNOSED PREOPERATIVELY BY COMPUTED TOMOGRAPHY

Abstract

Obturator formen hernias are rare and account for only O.4% of all cases of mechanical small bowel. These hernias may be difficult to diagnose by physical examination and abdominal radiographys. The resultant delay in diagnosis contributes to a high mortality rate. A 93-year-old woman was admitted to the hospital because of small bowel obstruction. Abdominal simple X-ray film confirmed complet small bowel obstruction, with distended intestinal loops seen in the pelvis. A correct preoperative diagnosis of obturator formen hernia was made by Computed Tomography (CT) findings which recognized a loop of ileum protruding between the pectineus and external obturator muscles. On laparotomy, a Richter's herniation of the distal ileum into left obturator formen was found. The ischemic ileum was resected and small bowel was reanastomosed. Obturator fromen hernia is commonly found in aged women and lacks in local symptoms. So it presents difficulty in diagnosing preoperatively. In this case without specific symptoms the correct diagnosis could be made by CT. CT can be a useful tool in the evaluation of small bowel obstruction and can lead to earlier diagnosis of obturator formen hernia.