A Patient With Small Bowel Obstruction Secondary to an Incarcerated Left Obturator Hernia

Obturator hernia, an infrequent pelvic hernia, which primarily affects thin elderly women, often leads to intestinal obstruction due to diagnosis delay resulting from the absence of specific symptoms and detectable signs. The delay in diagnosis and surgical intervention contributes to its relatively high morbidity and mortality rates. This case report discusses a woman in her 80s with a non-underweight BMI of 19.9 kg/m2 who experienced small bowel obstruction (SBO) due to an incarcerated left obturator hernia, which was found relatively late at day three post symptoms. The patient had a history of rapid unintentional weight loss, reduced oral intake, as well as symptoms suggestive of bowel obstruction, such as vomiting and obstipation, and was diagnosed preoperatively via Computerized Tomography (CT) imaging findings showing an incarcerated left obturator hernia. This case report presents a unique case of left-sided incarcerated obturator hernia, which is less common compared to right-sided obturator hernia due to anatomical reasons. Surgical intervention involved a mini lower midline laparotomy for the reduction and repair of the obturator hernia, and fortunately, no bowel resection was required due to the viability of bowel intra-operatively despite clinical concern of bowel ischemia due to the delay in surgical intervention resulting from the transfer of the patient from a regional area. Although many cases of obturator hernia are usually diagnosed intra-operatively, in this case report, we highlight the importance of considering the diagnosis of obturator hernia, especially in cases of elderly, thin female patients presenting with bowel obstruction, and to ensure an early pre-operative diagnosis, comprehensive history assessment, meticulous physical examination, and thorough diagnostic procedures, including a CT scan.