GS18P CASE SERIES: OBTURATOR HERNIA

Abstract

Obturator hernia is a very rare cause of small bowel obstruction accounting for only 0.073–1% of all hernias(1). Here we report two such cases.A 69 year old female presents with 11/2 day history of colicky abdominal pain, vomiting and left medial thigh pain.Past history includes an admission 2 year ago with small bowel obstruction treated conservatively, diverticular disease and no previous abdominal surgery.At presentation she was unwell with recurrent faeculent vomiting. The abdomen was soft but generally tender. The left medial thigh was tender. No femoral hernia.Abdominal films revealed a dilated loop of small bowel. Blood results: raised WCC 18.7 (4.0–10.0), CRP 66 (<5). Obturator hernia was suspected and CT confirmed this.Laparotomy revealed a Richter’s hernia and viable small bowel. The defect was primarily closed. Patient was discharged 4 days post operatively.An 89 year old female presented with several days of colicky abdominal pain and no bowel motions. She had multiple co‐morbidities including advanced Vascular Dementia, Asthma and Hypertension.At presentation she was unwell. Abdominal exam revealed right illiac fossa guarding with a normal WCC and a raised CRP 78. Arterial blood gas analysis revealed a metabolic alklosis with respiratory compensation.CT abdomen reported a small bowel obstruction due to right Obturator hernia with perforation. Due to her co‐morbidities she was managed conservatively and she passed away a week later.The management of Obturator hernias is still open to debate with a wide variety of methods being described.