Small Bowel Obstruction Secondary to Obturator Hernia: A Pre-Operative Diagnosis at Computed Tomography / Marlina Tanty Ramli Hamid ...[et al.]

• Main Authors: Ramli Hamid, Marlina Tanty, Mohd Khalid, Mohd Shukry, Rahmat, Kartini
• Format: Article
• Language: English
• Published: Universiti Teknologi MARA Cawangan Selangor Page Range: 2021
• Subjects: R Medicine (General); Surgery by region, system, or organ; Examination. Diagnosis
• Online Access: http://ir.uitm.edu.my/id/eprint/44355/1/44355.pdf; http://ir.uitm.edu.my/id/eprint/44355/; https://jchs-medicine.uitm.edu.my/index.php

Obturator hernia is rare, but it must be considered in elderly patients who present with small bowel obstruction. The diagnosis is challenging unless there is a high index of suspicion as the presenting symptoms and signs are usually non-specific. Presence of positive Howship- Romberg sign is considered pathognomonic. Early diagnosis and rapid surgical intervention will reduce the high morbidity and mortality associated with undiagnosed obturator hernia. We report a case of a 93-year-old female patient who was admitted to our surgical department with symptoms of intestinal obstruction of 3-days duration. Howship-Romberg sign was negative. Computed tomography (CT) demonstrated the presence of left obturator hernia with proximal small bowel obstruction and no sign of strangulation. The patient had emergency laparotomy post-CT where the incarcerated bowel loop was released and the obstructed bowel was decompressed without any complication. The hernial defect was close with a mesh and the patient had an uneventful recovery post-surgery. In this case, we highlight that diagnosis of obturator hernia must always be considered in elderly patients who present with intestinal obstruction. Urgent CT could establish a rapid pre-operative diagnosis and aids in appropriate surgical intervention planning which is crucial in optimising the outcome.