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

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.

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.

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.

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.