Rare case of incarcerated obturator hernia: Case report and review of literature

Abstract

Introduction: Obturator hernia is a rare condition accounting for less than 1% of all intra abdominal hernias. Clinical diagnosis is considered a challenge for most surgeons. It usually appears as an intestinal obstruction. Confirmation of diagnosis is carried out by means of imaging or during surgery.

Case report: An 85-year-old female patient, with symptoms of intestinal obstruction of 24h duration was admitted to the emergency room of Unimed Hospital - Belo Horizonte. Abdominal computed tomography (CT) demonstrated a herniation of the small bowel through the right obturator canal with an intestinal distension proximally. At laparotomy, the presence of a right obturator hernia with an ileal strangulation was confirmed. Segmental enterectomy with primary anastomosis and herniorrhaphy for the closure of the obturator foramen were performed.

Discussion: Obturator hernias typically affect women, elderly, emaciated and multiparous. Symptoms are non-specific and associated with an intestinal obstruction. Howship-Romberg sign, considered pathognomonic, is generally absent. Abdominal CT scan can aid in pre-operative diagnosis and the treatment is surgical.

Conclusion: Early diagnosis and surgical treatment are imperative in obturator hernias due to the high morbidity and mortality that occur in cases where the intervention is delayed.

Keywords: Howship-Romberg sign; Incarcerated hernia; Intestinal obstruction; Obturator hernia.

Fig. 1

CT images: A) axial section and B) sagittal section – Showing a bowel segment with hydro-aerial levels through the right obturator canal (arrows).

Fig. 2

Preoperative Images – A) herniation of ileal loops through the right obturator canal; B) Richter type hernia: impression in the ant mesenteric border of hernia content (arrows) associated with a Meckel diverticulum (arrow head); C) Obturator Foramen and D) Herniorrhaphia with double-layer mesh fixed with separate stitches.