• Tudor Bratiloveanu University of Medicine and Pharmacy of Craiova & Craiova Emergency Clinical County Hospital
  • Sarmis Săndulescu University of Medicine and Pharmacy of Craiova & Craiova Emergency Clinical County Hospital
  • Silviu Daniel Preda University of Medicine and Pharmacy of Craiova & Craiova Emergency Clinical County Hospital
  • Adrian Dobrinescu University of Medicine and Pharmacy of Craiova & Craiova Emergency Clinical County Hospital
  • Valeriu Șurlin University of Medicine and Pharmacy of Craiova & Craiova Emergency Clinical County Hospital
Keywords: strangulated, obturator, hernia, intestinal, obstruction


Comprising merely 1% of all abdominal wall hernias, obturator hernias exhibit a notable morbidity and mortality, with reported rates ranging from 15-25%, and in certain instances, escalating up to 70%. We present the case of a 79-year-old thin, frail lady who was admitted with a 5-day history of nausea, vomiting, constipation, and lower left quadrant abdominal pain that radiated down the left medial thigh. Howship-Romberg sign was positive. Plain X-rays revealed dilated bowel loops with multiple central air-fluid levels suggestive of complete small bowel (SB) obstruction with no signs of perforation. An urgent CT scan of the abdomen and pelvis was performed which found a dilated SB loop with a transition point caused by herniation through the left obturator foramen, suggestive of a strangulated obturator hernia. Decision to take the patient to surgery was adopted. After laparotomy, a segment of ileum was strangulated in the left obturator foramen. The SB segment was freed and found to be viable. A plug mesh repair was performed. This case report highlights the importance of considering obturator hernia in elderly, thin, multiparous women with chronic health conditions presenting with symptoms such as bowel obstruction or thigh pain. The diagnostic utility of imaging modalities, particularly CT scans, is crucial in accurately identifying obturator hernias preoperatively. Surgical intervention remains the mainstay of treatment, with a lower midline laparotomy being the preferred approach in emergency situations.


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