Abstract
Obturator hernia is rare. It occurs when part of the pelvic contents protrude through the obturator foramen. It is a diagnostic challenge in the emergency department since the signs and symptoms are non-specific. It often occurs in elderly, emaciated and chronically ill women. The clinical picture include intestinal obstruction with abdominal pain, nausea and vomiting. The treatment is only surgical. Delayed diagnosis of this condition usually leads to a high mortality rate. We report the case of an 83-year-old woman with a strangulated obturator hernia. The hernia was discovered early by computed tomography and was treated by emergency laparotomy. We emphasize on the rule of CT scan to establishing a prompt preoperative diagnosis of an obturator hernia, appropriate planning of surgical intervention and thus optimizing the outcome.
Highlights
Obturator hernia is a rare abdominal wall hernia with incidence of 1% [1]
We present a case of obturator hernia causing bowel obstruction which was diagnosed by CT scan and was successfully operated in emergency
The diagnosis of strangulated small-bowel obstruction secondary to a left obturator hernia was confirmed and the decision was to carry out surgery
Summary
Obturator hernia is a rare abdominal wall hernia with incidence of 1% [1]. It occur when the intestine protrudes through a defect in the obturator foramen and into the obturator canal [2]. A frail 83-year-old woman was admitted with a 48 h history of acute abdominal pain, absolute constipation and vomiting She had type 2 diabetes and had never undergone abdominal surgery. Clinical examination showed a moderate built patient with a temperature of 37.7°C, dry tongue and sunken eyes On local examination, she had a distended abdomen with generalized tenderness and no groin hernias. Urgent CT scan of the abdomen and pelvis performed with contrast (Figure 1) It revealed a dilated SB loops with a transition point caused by a lateral pinching loop of SB with herniation through the left obturator foramen; the loops down and the colon were collapsed. The diagnosis of strangulated small-bowel obstruction secondary to a left obturator hernia was confirmed and the decision was to carry out surgery.
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