Small intestine obstruction secondary to obturator hernia

Abstract

An 84-year-old lady presented with a 3-day history of abdominal distention and intermittent colic. She was underweight (body mass index of 12 kg/m2) and received adhesiolysis for ileus several years ago. Physical examination revealed diminished distal bowel sound and intermittent throbbing pain of right groin area. The kidney, ureter and bladder (KUB) radiography demonstrated small intestine obstruction (Fig. 1 A). Symptoms persisted despite of prokinetic agents and enema. Abdominal computed tomography (CT) disclosed bowel segment between right pectineus muscle and obturator externus muscle (Fig. 1B). Mechanical small intestine obstruction secondary to right obturator hernia was diagnosed, and symptoms relieved after segmental resection of incarcerated ileum via laparoscopy. (A) KUB radiography revealed small intestinal obstruction of coiled spring sign. (B) Herniated ileum (arrow head) was noted between right pectineus muscle and obturator externus muscle (arrows). Intestinal obstruction, the interruption of normal intraluminal flow, can be functional or mechanical. Etiologies of mechanical obstruction include postoperative adhesions, hernias, tumors, gallstones, foreign bodies, intussusceptions, etc. Obturator hernia, a rare type of herniation, is abdominal contents protruding through the obturator foramen. It is more common in the elderly and debilitated woman, also named the “little old lady's hernia” [1]. Formerly the diagnosis was established only on surgical explorations due to lack of specific diagnostic clues [2], and now it can be detected early and correctly before operation with the assistance of CT [3], which typically shows herniated bowel between pectineus muscle and obturator muscle. Surgical intervention is the most proper treatment option [1]. In typical patients with intestinal obstruction of unknown origin, image studies such as abdominal or pelvis CT should be considered for obturator hernia. All authors declare no conflicts of interest.