EP 444 A Rare Case of Strangulated Recurrent Obturator Hernia
Jennifer Ikegbunam, Sharmilaa Lagunathan, Imad-ud-din Saqib, Manoj JacobAbstract
Aim
Obturator hernia is a rare form of hernia, accounting for approximately 0.7% to 1.5% of all abdominal herniae. It is usually present in women of advanced age with a low body mass index. Presenting symptoms are usually non-specific and the diagnosis is primarily based on cross-sectional imaging. As the complication rate is high, early surgical treatment is warranted. There is no standard surgical technique due to the rarity of the condition. However, both laparoscopic and open repairs have been described with use of mesh for larger defects if the bowel is viable.
Methods & Results
We report the case of a 73-year-old previously fit and well lady who presented with a left sided strangulated recurrent obturator hernia. She had previously undergone an emergency laparoscopic assisted obturator hernia (suture) repair for obstruction. She presented with acute onset vomiting on a background of abdominal pain and reduced appetite for a few months. Her inflammatory markers were elevated. Imaging demonstrated a left sided obstructed obturator hernia. Intraoperatively, there was a gangrenous patch with contained perforation and purulent fluid within the pelvis, left paracolic and left subdiaphragmatic regions. Bowel resection and anastomosis was performed followed by extraperitoneal closure of the defect with sutures. She remained well postoperatively.
Conclusions
Obturator hernia is an important differential in elderly people with low body mass presenting with non-specific abdominal symptoms. Early diagnostic investigations and immediate surgical management are key to reducing complications.