A Rare Case of Acute Mechanical Intestinal Obstruction: Strangulated Obturator Hernia

Abstract

Obturator hernia is a rarely-seen type of abdominopelvic hernia. It is generally seen in thinner, old, multipara patients. The most frequently seen clinical sign is intestinal obstruction associated with strangulation. Diagnosis is generally made during operation in patients brought into emergency room because of intestinal obstruction. Delay in diagnosis in older patients results in higher rates of morbidity and mortality. Herein, we present a 68-year-old multipara patient who consulted to the emergency service with clinical manifestations of intestinal obstruction, and who was operated with the preoperative diagnosis of “strangulated obturator hernia” established by means of computed-tomography.

A Rare Cause of Small Bowel Obstruction: Incarcerated Obturator Hernia

“…Although ultrasonographic evaluation is generally not successful in diagnosis, it may provide information about edema and perfusion on the intestinal wall (2). Although the number of cases of preoperatively diagnosable OH cases has been increased along with prevalent use of abdominal CT, there are still many OH cases which are only intraoperatively diagnosed (9,11). Both of the patients presented in this paper had intestinal obstruction symptoms on admission and during examination.…”

“…OH, is more frequent in women due to broader pelvic diameter and obturator foramen as well as decreased adipose tissue around the obturator vessels with aging and malnutrition in time (5,8,11). Conditions which increase intraabdominal pressure, such as cachexia, multiparity, chronic lung disease, constipation, kyphoscoliosis and ascites, may be listed among the predisposing factors (2).…”

“…OH, accounts for 0.07-1.4% of all abdominal hernias. It has been known as a disease of elderly and skinny women (8)(9)(10)(11). It occurs more frequently in the right side (2,5,10).…”

Emergency incarcerated obturator hernia repair with biologic mesh in a male patient after ipsilateral hip disarticulation: A case report

“…The challenges of this case arose from the difficulty of diagnosing the herniation at the onset of management. Obturator hernias typically appear in older, thin females due to decreased adipose tissue surrounding and protecting their widened obturator foramen, so the patient being a middle-aged male combined with the rare nature (<1% of all hernias) made an initial diagnosis more challenging [11] . The notion of the anatomy alteration from the amputation contributing to the herniation was not initially considered, but knowledge of this could have been an important clinical clue for faster treatment.…”