Left-sided obturator hernia presenting with bowel obstruction in an elderly female: A rare case report and literature review.

Abstract

<h4>Introduction and importance</h4>Obturator hernia (OH) is a rare, potentially fatal cause of small bowel obstruction, mainly affecting elderly, thin females. Diagnosis is often delayed due to nonspecific symptoms, causing high morbidity and mortality. Left-sided OH is uncommon because of sigmoid colon protection. We present a left sided OH case managed with a novel appendiceal orifice decompression technique.<h4>Case presentation</h4>An 80-year-old cachectic female (BMI 18 kg/m²) had five days of obstipation, bilious vomiting, abdominal distension, and pain. Clinical examination and abdominal radiographs suggested small bowel obstruction. Contrast-enhanced CT revealed a left obturator hernia containing ileal loops with dilated proximal bowel. Emergency laparotomy confirmed an 11.7 × 10.9 × 7.2 mm left obturator canal defect containing viable ileal loops. Herniated bowel was reduced, followed by appendectomy. Small bowel was decompressed via the appendiceal orifice, avoiding enterotomy. The defect was repaired with preperitoneal polypropylene mesh. The patient recovered uneventfully and was discharged on postoperative day 7, remaining asymptomatic at six months.<h4>Clinical discussion</h4>OH, often presents with vague symptoms, complicating diagnosis. CT is the imaging modality of choice. Left-sided OH is rare. Appendiceal orifice decompression offers a bowel-conserving option in selected frail patients with a healthy appendix. Risks include stump leak and infection. Evidence is limited, requiring further studies for standardization.<h4>Conclusion</h4>Early CT diagnosis and individualized surgical management are crucial. Appendiceal orifice decompression may be considered in high-risk patients, though further evidence is needed to define indications and safety.