Obturator Hernia Which was Combined with Inguinal Hernia and Hiatal Hernia

ABSTRACT

Obturator hernia is a rare type of hernia, which is difficult to detect early because of its nonspecific symptoms. A delayed diagnosis could lead to high morbidity and mortality. We experienced an unusual patient who had multiple hernias including an obturator hernia. A very thin 85-year-old woman visited hospital complaining of pain in the right thigh and knee. One week later, she was admitted again due to whole abdominal pain and vomiting. The abdominal simple radiographs showed a small bowel obstruction. On Abdominal CT, a herniated small bowel was located between the right pectineus muscle and the right external obturator muscle. A concomitant right inguinal hernia, which contained fatty tissue, was observed. A coincidental hernia of the stomach into left chest was also noted. Laparotomy revealed a strangulated small bowel in a right-sided obturator foramen and an impacted omentum in a right-sided inguinal canal. The terminal ileum was perforated at the proximal site from the incarcerated portion. A 10 cm length ileum including the perforation site was resected, which was followed by a primary anastomosis. The hernial defect was closed with a prosthetic mesh plate. In conclusion, the use of a of permanent mesh in an obturator hernia is a adequate method for closing an obturator hernia.