Obturator hernia cause of ileus – modern diagnosis and surgical approach

Abstract

Introduction: The obturator hernia (OH), which is considered relatively rare, is actually the most common of all hernias types of the pelvic floor. It represents 0.073% of all external hernias. Frequency is greater in older women between the 7th and 9th decades. The male: female ratio is 1:6. It mainly presents with symptoms of small bowel obstruction and accounts for 0.2-1.6% of all causes of ileus. Other concomitant complaints are pain in the thigh radiating to the knee (a symptom of Howship-Romberg) or swelling in the inguinal region with abdominal pain. Case Report: We present an 83 -year -old woman who was admitted to the Surgery department of the Military Medical Academy – Sofia with complaints of abdominal pain, vomiting and stop of defecation for several days. From the tests done, ileus of small intestinal origin was established. The diagnosis of incarcerated, obturator hernia was made after a contrast-enhanced CT scan of the abdomen and pelvis. The patient underwent emergency surgery, during which the incarcerated, small intestinal loop was released, retrograde debarasage of the small intestine and plastic of the obturator channel with its own tissues was done. Conclusions: Small bowel obstruction caused by incarceration in obturator hernia is one of the rare causes of intestinal obstruction in surgery, but on the other hand is a common manifestation in this type of hernia and one of the main causes of its detection. The combination of operative technique for the treatment of ileus condition and the plastic of the obturator channel produces good postoperative results.