Richter's type of obturator hernia with Howship Romberg sign: a case report

Obturator hernia is a rare type of pelvic hernia in which intraperitoneal contents protrude through the obturator foramen and is most commonly found in females. It accounts for about 1% of all abdominal hernias and possesses a great diagnostic challenge due to the non-specific symptoms and meagre clinical signs. Hereby we report a case of obturator hernia in an nonagenarian emaciated fragile old lady who presented with features of acute Intestinal obstruction and was diagnosed using computed tomography as right sided obturator hernia and eventually was taken up for emergency laparotomy. The herniated segment was resected and anastomosis was done with primary closure of the defect. Postoperative period was uneventful and the patient was discharged on postoperative day 7.

OV13 LAPAROSCOPIC APPROACH IN EMERGENCY HERNIA SURGERY: MANAGEMENT OF ACUTE SMALL BOWEL OBSTRUCTION SECONDARY TO STRANGULATED OBTURATOR HERNIA

Aim Acute small bowel obstruction secondary to strangulated obturator hernia is a rare condition, with high rates of morbidity and mortality in the absence of prompt diagnosis and intervention. We aim to describe a case with the above presentation, managed using a minimally-invasive approach with positive outcomes. Material and Methods We describe a case of an 82-year-old female who presented with acute small bowel obstruction secondary to strangulated obturator hernia on cross-sectional imaging. Results The patient underwent emergency surgery using laparoscopic approach for repair of obturator hernia and assessment of obstructed small bowel. Our approach involved identification and reduction of small bowel loop. A transabdominal preperitoneal approach was made to obturator hernia and ischaemic sac was reduced followed by closure of defect with a plug of biologic mesh. A linear segment of ischaemic small bowel was oversewn. Total operative time was 90 minutes. Conclusions Minimally-invasive surgery is an important tool in the armamentarium of the acute care surgeon. A laparoscopic approach will reduce the insult of intervention in already physiologically deplete patients. This case demonstrates the feasibility of laparoscopy for small bowel obstruction secondary to strangulated obturator hernia in the acute setting, requiring advanced laparoscopic skill as demonstrated in this video.