A rare cause of intestinal obstruction: incarcerated femoral hernia, strangulated obturator hernia

Abstract

Obturator hernia may occur bilaterally in association with another hernia, which is usually of the femoral type. We present a 77-year-old-woman who had abdominal pain with nausea and vomiting together with swelling of the right groin for 3 days. Incarcerated right femoral hernia and consequent mechanical small-bowel obstruction was diagnosed, and urgent operation was undertaken. As the incarcerated femoral hernia reduced spontaneously during the induction of anesthesia, a lower median incision was performed. During exploration, the real cause of mechanical intestinal obstruction was found to be a small intestinal loop strangulated in the left obturator hernia. Right femoral and left obturator hernia were repaired with preperitoneal polypropylene mesh. If there is enough time and general condition of the older patient is suitable, further diagnostic techniques for concomitant obturator hernias may be useful in patients who present with signs of incarcerated inguinal hernia and intestinal obstruction.

Small bowel obstruction secondary to bilateral obturator hernia: a rare occurrence

“…The pathognomonic Howship–Romberg sign, which is pain along the distribution of the obturator nerve, is present in 37% of patients. High morbidity in OH is directly related to the advanced age of the patients, diagnostic delay, gangrene and bowel perforation, deterioration and disability of the patients, and associated chronic diseases [7, 8]. As such, conservative management has little or no place in the management of OH, as is proved in our case where conservative management did eventually fail.…”

Little Old Lady’s Hernia: Obturator Hernia

“…Obturator herniler tüm abdominopelvik herniler içerisinde % 0.07 'lik kısmı oluşturmaktadır [1]. İleri yaş, düşük vücut ağır-lığı, düşük vücut kitle oranı (13-19 arası), multipar kadın olma, kronik obstrüktif akciğer hastalığı gibi karın içi basıncının arttığı durumlar, obturator herni gelişimine yatkınlık oluşturur [3].…”

“…Nadir görülür ve mekanik barsak obstrüksiyonu olan hastaların yaklaşık % 0.4 'ünü oluşturur [1]. Yaşlı, zayıf ve multipar kadınlarda daha sık görülür.…”

“…Obturator herninin en sık görülen bulgusu; strangülasyonla birlikte intestinal obstrüksiyondur. Herni kesesinin içine en çok ileum ve jejunum ansının girdiği bildirilmiştir [1]. Önceleri tanı genellikle operasyonda konulabilirken, bilgisayarlı tomografinin (BT) yaygınlaşması sonrası operasyon öncesi dönemde de tanı koymak mümkün olabilmektedir.…”

Diagnosis of an obturator hernia by CT

“…They have a high mortality rate of up to 40% due to strangulation,2 and patients often present with non-specific symptoms. The clinical presentation varies, depending on the contents of the hernial sac and the degree of herniation 3.…”