Uncovering the Mystery of the Obturator Hernia: The Overlooked Entity in Abdominal Wall Surgery

Background We present a paradigmatic clinical case of a female patient, attended in the emergency room for small bowel occlusion due to an incarcerated obturator hernia. Material and Methods 80-year-old woman with abdominal distension, pain and nausea for several days. She went to the emergency department on two occasions, with a clinical diagnosis of constipation and treatment with laxatives. On the fourth day, the patient associated vomiting and absolute oral intolerance. The CT scan shows a strangulated obturator hernia as responsible for the obstructive condition. Laparoscopic approach was initially attempted to achieve reduction of the hernia. However, intestinal ischemia and perforation are identified, so we converted to open surgery. A 10 cm segment of small bowel was resected; the hernia defect was treated by primary closure of the obturator hole. Results Postoperative evolution was complicated by persistent ileus and the two abdominal collections that were drained by interventional radiology. In addition, infection and dehiscence of the upper third of the surgical wound, treated with negative pressure therapy cures. Fortunately, after the torpid evolution, the patient is well and six months later there is no hernia recurrence. Conclusions Obturator hernia is an uncommon pathology. It appears in old, thin women, mainly on the right side. Its diagnosis is based on physical examination and imaging tests (CT is the gold standard test), although clinical suspicion from the first moment is essential to make an early diagnosis and treatment to avoid complications (strangulation, resection). Treatment is based on primary closure of the hernia or the use of flaps or prostheses.