Case Report: Radiologic disappearance of an incarcerated obturator hernia on sequential CT imaging before elective...

Obturator hernia (OH) is a rare but potentially life-threatening pelvic hernia associated with delayed diagnosis, bowel strangulation, and high mortality. We present a rare case of spontaneously reduced right obturator hernia documented by sequential computed tomography (CT) imaging and successfully treated with elective laparoscopic transabdominal preperitoneal (TAPP) mesh repair. A 67-year-old thin woman presented with acute lower abdominal pain associated with medial right thigh pain consistent with a positive Howship-Romberg sign. Initial non-contrast CT performed at a district hospital demonstrated a right obturator hernia with incarcerated bowel protruding through the obturator canal. However, following interhospital transfer, the patient experienced complete spontaneous symptom resolution, and repeat contrast-enhanced CT no longer demonstrated the herniated bowel loop or evidence of bowel obstruction. Despite apparent clinical and radiologic improvement, the previously documented obturator defect was considered at high risk for recurrent incarceration and strangulation. Elective laparoscopic TAPP repair performed three days later confirmed a widened right obturator defect without residual incarcerated bowel, and prosthetic mesh reinforcement was completed successfully without bowel resection or perioperative complications. The postoperative course was uneventful. This case highlights the diagnostic challenge of spontaneously reduced obturator hernia and emphasizes the importance of correlating prior imaging findings with clinical evolution, even when repeat imaging appears normal. Sequential CT imaging uniquely documented the dynamic transition from incarcerated obturator hernia to spontaneous reduction, thereby preventing missed diagnosis through careful correlation of prior and repeat imaging findings despite complete symptom resolution.