Intestinal Obstruction Secondary to Strangulated Richter Type Obturator Hernia: A Case Report

Obturator hernia is a rare internal hernia causing significant mortality and morbidity in elderly age groups. Diagnosis of obturator hernia is challenging because of vague atypical presentations. This case report describes a woman in her late 80s who presented with colicky right lower abdominal pain, abdominal distension, and obstipation, diagnosed with a right obturator hernia, computed tomography (CT) scan. An elderly female presented with chief complaints of right lower abdominal pain and abdominal distension. On examination, the abdomen was distended with generalized tenderness and rebound tenderness. CECT abdomen and pelvis showed dilated small bowel loops with a transition point caused by herniation through the right obturator foramen. Emergency laparotomy revealed a right strangulated obturator hernia. Resection of the gangrenous ileal segment with ileo-ileal anastomosis and primary closure of the defect was done. Obturator hernia occurs through the obturator canal, which is mostly seen in elderly females. Obturator hernia usually presents as partial bowel obstruction because of a high frequency (41%-100%) of Richter's herniation of the small bowel into the obturator canal. Diagnosis can be delayed because of its nonspecific clinical presentation. CT scan is the most accurate and sensitive way to diagnose the obturator hernia. Obturator defects can be repaired by various methods including simple suture closure, closure of the obturator with adjacent tissue, and mesh placement during laparotomy. Obturator hernia is a rare abdominal hernia with delayed diagnosis because of vague atypical clinical presentation. Early diagnosis and prompt surgical treatment are essential to reduce morbidity and mortality.