Small Bowel Obstruction due to Incarcerated Obturator Hernia

Kim, Yong Hoon; Lim, Deok Ho; Kim, Bong Soo; Hwang, Yong Hee; Jeong, Yong Hwan

Abstract

An obturator hernia is a rare but important cause of small bowel obstruction, due to the difficulty of its diagnosis and the high mortality rate. Elderly, multiparous and debilitated women with comorbid illnesses are most often affected, and this hernia, coupled with a delay in the diagnosis and operative intervention, results in the high mortality rate, which represents both diagnostic and therapeutic challenges to the surgeon. Recently, we experienced two unusual obturator hernia cases, where incarceration had lead to a small bowel obstruction. One patient was an 82-year-old woman with a compression fracture of the lumbar spine, which presented with left inguinal pain and abdominal distension. The abdominal plain X-ray showed evidence of a small bowel obstruction. The hernia was diagnosed by a computed tomography (CT) scan and repaired using the lower midline transperitoneal approach. To prevent a recurrence, the hernial defect was enforced with a polypropylene plug and mesh. The other patient was a 92-year old woman with fracture of the neck of the left femur, which presented with defecation difficulty and abdominal distension. The abdominal plain X-ray showed multiple distended small bowel loops consistent with small bowel obstruction. A contrast-enhanced CT scan of the abdomen and pelvis showed a right obturator hernia with strangulation. We recommended an emergency operation, but the patient refused the operative procedure. With on going conservative management, the symptom was fortunately resolved. Herein, we report these findings with a brief review of the literature.