Double-Incision Surgical Management of Incarcerated Obturator Hernia Presenting With Acute Right Lower Abdominal Pain in a 67-Year-Old Woman.

Abstract

BACKGROUND Herniation of the bowel through the obturator foramen is a rare cause of intestinal obstruction. It occurs more frequently in elderly, thin women and typically presents on the right side. Because of its deep pelvic location, diagnosis is often delayed, and emergency surgery is usually required. When reduction is difficult, alternative approaches, such as the double-incision technique, can facilitate safe and effective management. This report presents the case of a 67-year-old woman with acute right lower abdominal pain due to an incarcerated obturator hernia, managed with a double-incision approach, segmental bowel resection, and entero-enterostomy. CASE REPORT A 67-year-old woman presented with acute right lower abdominal pain and symptoms of intestinal obstruction. Abdominal computed tomography (CT) revealed an incarcerated obturator hernia. Emergency surgery was performed through a lower midline incision, but reduction of the herniated bowel was unsuccessful due to severe edema and tight incarceration. A secondary groin incision was made to access the obturator canal directly. The necrotic bowel segment was resected, and an entero-enterostomy was performed. The patient recovered uneventfully and was discharged on postoperative day 10. CONCLUSIONS This case highlights the importance of prompt diagnosis and emergency surgical treatment of incarcerated obturator hernia to prevent bowel ischemia, necrosis, and potentially fatal complications. A combined approach using an additional groin incision allowed for safe management, including decompression, adhesiolysis, and resection of the necrotic bowel. This approach enables safe decompression, adhesiolysis, and resection, thereby minimizing intraoperative risk and improving postoperative outcomes in complex cases.