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Case Reports
. 2025 Jun:131:111398.
doi: 10.1016/j.ijscr.2025.111398. Epub 2025 May 1.

Strangulated right obturator hernia in an elderly patient: A case report

Jasser Yaakoubi  1 , Aziz Atallah  1 , Mohamed Guelbi  2 , Mohamed Mehdi Kamoun  1 , Hafedh Mestiri  1 , Sahir Omrani  1
Affiliations
Case Reports

Strangulated right obturator hernia in an elderly patient: A case report

Jasser Yaakoubi et al. Int J Surg Case Rep. 2025 Jun.

Abstract

Introduction: An obturator hernia is a rare condition representing less than 1 % of abdominal hernias and responsible for 0.05 to 1.4 % of cases of mechanical obstruction of the small intestine [1] typically affecting elderly, emaciated, multiparous women. Strangulation is a frequent complication and is generally the main clinical presentation. The positive diagnosis is often difficult because of the low specificity, hence the importance of sectional imaging. Surgical management must be initiated urgently to reduce the rate of morbidity and mortality.

Presentation of case: A 79-year-old woman with a history of achalasia and esophageal squamous cell carcinoma undergoing radiotherapy presented with a five-day history of acute abdominal pain, vomiting, and abdominal distension. Clinical examination revealed diffuse tenderness with no palpable hernial orifices. Laboratory tests indicated an inflammatory response, and an abdominal CT scan demonstrated bowel distension with an ileal loop incarcerated in the right obturator foramen. Following brief resuscitation, she underwent midline laparotomy. Intraoperative findings confirmed a strangulated ileal loop with preserved vitality, along with an incidental left obturator hernia. Both obturator foramina were repaired using sutures and reinforcement with adjacent tissue.

Discussion: The non-specific nature of symptoms often delays diagnosis, making CT imaging the gold standard for early detection. Prompt surgical intervention is vital to reduce the high morbidity and mortality associated with obturator hernias.

Conclusion: Although rare, obturator hernias require high clinical suspicion in high-risk populations. Early diagnosis through CT imaging and immediate surgical management are essential for improving patient outcomes and reducing complications.

Keywords: Case report; Hernia; Obturator; Surgery.

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Conflict of interest statement

Declaration of competing interest All authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
CT images in coronal (A), axial (B), and sagittal (C) planes showing a bowel loop (yellow arrow) passing through the right obturator canal, incarcerated between the pectineus and obturator externus muscles, through a narrow neck measuring 14 mm. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
A distal ileal loop incarcerated in the obturator foramen.
Fig. 3
Fig. 3
The incarcerated ileal loop after reduction.
See this image and copyright information in PMC

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