193 A rare cause of small bowel obstruction- Obturator Hernia

Abstract

Obturator hernias are clinically challenging to diagnose, and the incidence reported in the medical literature is between 0.05% to 2.2%. This is commonly seen in thin, elderly female patients. Computed tomography is the gold standard for diagnosis. The mortality has been reported as 12-70%. Here, we present a 90-year-old female with complaints of abdomen pain, distention, vomiting and bowels not opening for a few days. She had a background of severe frailty, poor mobility and comorbidities such as hyperlipidaemia and mild cognitive disorder. On clinical examination, her abdomen was distended on examination with diffuse tenderness. Her blood investigations were normal, apart from CRP 26mg/L. Her abdominal X-Ray showed dilated loops of small bowel in the central abdomen. Computed tomography of the abdomen and pelvis showed high-grade mechanical distal small bowel obstruction with a transition point to probably in the right iliac fossa. She had an emergency laparotomy and was found to have an obturator hernia with bruised but viable small bowel. Hernial contents reduced. Postoperatively she developed hospital-acquired pneumonia, for which she was treated with antibiotics and later discharged. It is a rare case with a high chance of getting missed on clinical examination. In case of diagnostic uncertainty, CT should be promptly performed. Knowledge about this rare acute surgical condition is required for clinical suspicion, appropriate investigation and diagnosis, as the mortality is high.