Incarcerated obturator hernia resulting in small bowel strangulation: A case report.

Abstract

<h4>Rationale</h4>Obturator hernia (OH) is a rare but serious cause of mechanical bowel obstruction that predominantly affects older women who are underweight. OH has a nonspecific presentation and high rates of strangulation and mortality, and it poses a significant diagnostic challenge. This case report highlights the importance of early recognition and demonstrates a minimally invasive surgical approach for OH with bowel necrosis.<h4>Patient concerns</h4>A 68-year-old female with a body mass index of 19.1 kg/m² presented with a 48-hour history of abdominal pain, distension, and obstipation, accompanied by pain radiating from the left hip to the knee (Howship-Romberg sign).<h4>Diagnoses</h4>Initial computed tomography (CT) findings without pelvic views were inconclusive. The diagnosis of an incarcerated left OH with small bowel strangulation was confirmed after 3 days via contrast-enhanced abdominopelvic CT.<h4>Interventions</h4>A hybrid laparoscopy-assisted approach with a small laparotomy incision was performed for bowel resection and hernia repair.<h4>Outcomes</h4>The patient recovered uneventfully and was discharged without complications. After 17 months of follow-up, the patient remained asymptomatic with normal eating and bowel habits and no abdominal complaints.<h4>Lessons</h4>This case report emphasizes that OH must be considered in older women who are underweight, presenting with unexplained small bowel obstruction. Abdominopelvic CT imaging is the gold standard for OH diagnosis. A laparoscopy-assisted approach with a small incision is a feasible and beneficial surgical strategy for managing acute incarcerated OH even when intestinal resection is required, potentially reducing postoperative morbidity and hastening recovery.