Recurrent Strangulated Obturator Hernia

ABSTRACT

An obturator hernia is a rare condition, occurring most frequently in elderly and debilitated women. The diagnosis is difficult, and delayed treatment is associated with serious complications. In most cases, it produces a small bowel obstruction with high morbidity and mortality. We experienced an unusual case of a left recurrent obturator hernia. The patient was a 76-year-old woman with atrial fibrillation, presented with intermittent generalized abdominal pain and distension. The patient underwent a laparotomy because of a left incarcerated obturator hernia 2 years ago. The abdominal plain X-ray showed evidence of a small bowel obstruction. A CT scan established a correct diagnosis. Consequently, the patient underwent an immediate laparotomy. There were a few necrotic foci on the herniated small bowel wall. Therefore, a segmental resection of the small bowel was performed. To prevent a recurrence, the hernial defect was closed with several interrupted sutures between the peritoneum and periosteum of the obturator foramen. As patients with an obturator hernia are almost elderly women, and often have multiple concurrent medical problems. An immediate CT scan of the abdomen, including the pelvic area, should achieve an early diagnosis. Early surgical intervention should be done without serious medical diseases. Besides definitive surgery is needed to prevent a recurrence.