P-089 OBTURATOR HERNIA: A RARE CASE OF INTESTINAL OBSTRUCTION REQUIRING SEVERAL TYPES OF TREATMENT

Abstract

Abstract Background Obturator hernia is infrequent (incidence 1%). This condition usually occurs in older, multiparous women. Case Report We report two cases of this pathology: The first one deals with a woman that presents insidious abdominal pain, who underwent an abdominal CT scan compatible with mechanical intestinal obstruction secondary to present the ileum trapped in a right obturator hernia. Treatment consisted of a laparoscopic approach creating a peritoneal flap, hernioplasty with polypropylene mesh and closure of the flap with V-lock 3/0. The last one is about an elderly woman who presents nausea and vomiting accompanied by severe pain in the left lower limb. An abdominal CT scan was performed, which revealed a distal jejunal loop into the left obturator accompanied by intestinal obstruction. Open henioplasty was performed due to significant adhesive syndrome. The hernia sac was reduced, preperitoneal plug was placed and the orifice was closed with vycril suture. Discussion Diagnosis is complex due to the characteristics of the patients. There are 3 signs of strangulated hernia: obturator neuralgia, pain in the medial thigh due to obturator nerve compression and the absence of the adductor reflex in the thigh. The most accurate diagnostic test is the CT scan. Three treatment techniques are described: transabdominal, extraperitoneal and laparoscopic. Conclusion Despite of obturator hernia is not a frequent cause of intestinal obstruction, we should consider the laparoscopic approach as an option with fewer postoperative complications, when possible.