915 Obturator Hernia: A Case Report of Intestinal Obstruction in a 79yo Male with Challenging Diagnosis and Non-Standardised Treatment
B Finch, I Chishti- Surgery
Abstract
Introduction
Obturator Hernia (OH) is a rare condition that accounts for <1% of all abdominal wall hernias but is associated with the highest mortality and morbidity. OH in men are especially rare, with a male:female ratio of 1:14. Early surgical intervention is often delayed due to clinical and radiological diagnostic difficulties. At present, there are no international guidelines for treatment or best surgical approach to manage this condition.
Case Presentation
We present the case of an emaciated 79-year-old male with a 12-day history of right iliac fossa pain radiating to the right thigh, with a 2-day history of absolute constipation, vomiting and significant weight loss. This patient had a surgical history of elective right open inguinal hernia, on background of moderate-COPD. CT imaging revealed small bowel obstruction secondary to a small right obturator hernia containing a loop of small bowel. The patient underwent an exploratory laparotomy with intra-operative findings of 1cm defect in the right obturator foramen containing viable small bowel with incidental finding of right-sided femoral hernia; both defects corrected with PDS interrupted sutures. Iatrogenic perforation of the small bowel during hernia-reduction resulted in small bowel resection with primary anastomosis. The patient developed ileus requiring TPN post-operatively. During follow-up, there was no evidence of recurrence or further complications.
Conclusion
OH diagnosis is challenging owing to its rarity and non-specific presentation. Surgical intervention is the only definitive management for OH, thus awareness of this condition is crucial to allow an earlier approach and attempt to mitigate the associated high morbidity and mortality rates.