Bilateral Obturator Hernia Diagnosed by Computed Tomography: A Case Report with Review of the Literature

Obturator hernia is a rare form of abdominal hernia and a diagnostic challenge. It is commonly seen in elderly thin females. Its diagnosis is often delayed with resultant increased morbidity and mortality due to bowel ischemia/gangrene. It is mistakenly diagnosed as femoral or inguinal hernia on USG. Computed tomography is diagnostic and is a valuable tool for preoperative diagnosis. This report presents a case of 70-year-old thin female presenting with intestinal obstruction due to left sided obstructed obturator hernia. USG showed small bowel obstruction and an obstructed left sided femoral hernia. CT scan of abdomen and pelvis with inguinal and upper thigh region disclosed left sided obturator hernia. It also detected clinically occult right sided obturator hernia. Early diagnosis and surgical treatment contribute greatly in reducing the morbidity and mortality rate. 1. Introduction An obturator hernia is a rare cause of all abdominal wall hernias commonly seen in females. Its clinical diagnosis is often difficult due to uncommon incidence, its deep location, and infrequent symptoms and signs. Delay in its diagnosis causes poor prognosis with increased morbidity. Early CT imaging establishes diagnosis and detects asymptomatic contralateral obturator hernia. The following case report highlights these diagnostic difficulties and reviews the current literature on diagnosis and management of such cases. 2. Case Report 70-year-old known hypertensive female patient presented with intermittent abdominal pain and vomiting for 2 days. She gave past history of pulmonary Koch’s 10 years back for which she completed AKT. On examination the patient was thin-built, conscious, and well oriented. Blood pressure was 150/90？mmHg. Respiratory rate was 22/min. Per abdomen examination showed mild abdominal distension. She was referred for USG Abdomen and Pelvis. USG Abdomen and Pelvis showed mild dilatation of small bowel loops in entire abdomen (caliber = 3–3.5？cm) with intermittent to-and-fro peristalsis. Mild free fluid was noted in pelvis and in between small bowel loops. Left inguinal and left upper thigh region showed a herniated small bowel loop extending in medial aspect of upper thigh which was irreducible. A diagnosis of obstructed and irreducible left femoral hernia was made. X-ray standing abdomen (Figure 1) revealed dilated small bowel loops in mid and lower abdomen with no pneumoperitoneum. She was referred for emergency plain CT scan of abdomen and pelvis. Small bowel loops in abdomen and pelvis appeared fluid-filled and dilated of caliber 3–3.5？cms