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Strangulated obturator hernia: still deadly.

¹Department of Internal Medicine, University of South Alabama Medical Center, Mobile 36617, USA.

Southern Medical Journal

|February 24, 2001

Summary

An incarcerated obturator hernia caused severe pain and vomiting in an elderly patient. Prompt diagnosis via computed tomography (CT) and surgery are crucial for survival due to the high mortality rate of this abdominal hernia.

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Area of Science:

Gastroenterology
Surgical Case Reports
Medical Diagnostics

Background:

Obturator hernias are rare abdominal wall defects, often presenting with subtle or atypical symptoms, particularly in the elderly.
Delayed diagnosis of incarcerated obturator hernias is associated with significant morbidity and mortality.
Small bowel obstruction symptoms can mask the underlying cause, necessitating a high index of suspicion.

Observation:

An elderly, emaciated female presented with recurrent lower abdominal and hip pain, nausea, and vomiting.
Physical examination revealed a Howship-Romberg sign and a tender rectal mass, suggestive of obturator hernia.
Computed tomography (CT) confirmed an incarcerated obturator hernia causing small bowel obstruction.

Findings:

The patient's symptoms, physical exam findings (Howship-Romberg sign, rectal mass), and CT scan rapidly led to the diagnosis of an incarcerated obturator hernia.
The case highlights the diagnostic challenges posed by obturator hernias, especially in frail, elderly patients.
Early recognition and surgical intervention are paramount for improving outcomes.

Implications:

This case underscores the importance of considering obturator hernia in the differential diagnosis of abdominal pain and small bowel obstruction in the elderly.
A high index of suspicion and timely diagnostic imaging (CT) are critical for rapid diagnosis.
Prompt surgical management is essential to reduce the high mortality associated with incarcerated obturator hernias.

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