Richter type of incarcerated obturator hernia: misleading all the way

Abstract

Obturator hernia is a rare type of abdominal hernia where herniation occurs through the obturator canal. It develops predominantly in elderly underweight women. It has unspecific early symptoms, which is the reason these hernias are usually discovered only after they have become incarcerated. Incarcerated obturator hernias are usually discovered on abdominal computed tomography (CT) scan or emergency surgery due to bowel obstruction. We present a case of an 85-year-old female patient who was admitted because of intermittent abdominal pain and vomiting. Consecutive upright abdominal x-rays failed to show bowel obstruction. Abdominal CT scan revealed a right-sided incarcerated femoral hernia that was not found during emergency surgery. After laparotomy had been performed, a Richter type of right-sided incarcerated obturator hernia was discovered with a small necrotic area on the small bowel. Bowel resection was performed and obturator hernia was closed with interrupted sutures. The patient recovered without complications. Obturator hernia, due to its rarity and unspecific early symptoms, can still be misleading even to the most experienced surgeons. Delayed diagnosis of obturator hernia can lead to bowel necrosis and perforation with significant postoperative morbidity and mortality.