Obturator hernia of Richter type: a diagnostic dilemma

Abstract

An 85-year-old malnourished woman presented with symptoms of small bowel obstruction of uncertain aetiology. She had presented numerous times over the previous 2 years with symptoms of left groin and thigh pain, vomiting and abdominal distension. A CT of her abdomen and pelvis ultimately revealed a left-sided pelvic hernia, between the obturator internus and pectineal muscles. This was consistent with an obturator hernia. Diagnostic laparoscopy confirmed an obturator hernia of Richter type, incarcerated within the left obturator canal. Reduction revealed a hernia sac containing viable small bowel. A primary repair was performed using a double-layer suture technique to both close and plug the hernia defect. The patient rapidly recovered following hernia repair, with resolution of all previous long-standing symptoms. This case exemplifies the typical presentation of an obturator hernia and the diagnostic challenge it poses to clinicians.

An unusual case of early-stage obturator hernia causing bowel obstruction and strangulation

“…The obturator foramen is formed by the superior ramus of the pubic bone, inferior ramus of the pubic bone, and ischium bone. It is covered by the obturator membrane [2] . Obturator hernias are most common in elderly women who have a history of multiple pregnancies.…”

Little old lady’s hernia: a case of strangulated obturator hernia in a 88-year-old woman

“…Obturator hernia was first described by Ronsil in 1724 and successfully repaired by Henry Ombre in 1851. 1,2,6 It refers to the herniation of abdominal contents through the obturator canal. 1,2,4,6 It is a relatively rare type of hernia, representing at least 0.05% to 2,2% of all hernias, and it causes 0.2% to 1.6% of all small bowel obstuctions [1][2][3][4][5][6][7] Most patients with obturator hernia are small, emaciated, elderly females, hence called the 'little old lady's hernia'.…”

“…1,2,6 It refers to the herniation of abdominal contents through the obturator canal. 1,2,4,6 It is a relatively rare type of hernia, representing at least 0.05% to 2,2% of all hernias, and it causes 0.2% to 1.6% of all small bowel obstuctions [1][2][3][4][5][6][7] Most patients with obturator hernia are small, emaciated, elderly females, hence called the 'little old lady's hernia'. 1,3,4,7 Obturator hernia can present with incarceration and acute intestinal obstruction.…”

“…1,2,4,6 It is a relatively rare type of hernia, representing at least 0.05% to 2,2% of all hernias, and it causes 0.2% to 1.6% of all small bowel obstuctions [1][2][3][4][5][6][7] Most patients with obturator hernia are small, emaciated, elderly females, hence called the 'little old lady's hernia'. 1,3,4,7 Obturator hernia can present with incarceration and acute intestinal obstruction. 1 It has a high rate of mortality (12-70%) which may be related to the delay in diagnosis due to a lack of specific signs.…”

“…1,3,4,7 Obturator hernia can present with incarceration and acute intestinal obstruction. 1 It has a high rate of mortality (12-70%) which may be related to the delay in diagnosis due to a lack of specific signs. 1,2,4,7 This delay will retard the treatment and thus can trigger irreversible injury to hernia contents like gangrenous bowel, viscus perforation, and peritonitis which may lead to death.…”