Obturator Hernioplasty With Tapp Technique for Strangulated Hernia

Introduction Obturator hernias are a rare entity, accounting for 0.04% of all hernias. They are almost exclusive to women, especially in the seventh and eighth decades of life. Diagnosis is often delayed, and the most common presentation is incarceration. Clinical case We present the case of a 78-year-old woman with no significant surgical history who came to the Emergency Department with a 72-hour history of intestinal obstruction. Abdominal CT scan revealed findings consistent with an incarcerated right obturator hernia. Urgent surgical treatment was decided, and a TAPP hernioplasty was performed. The procedure started with the placement of a supraumbilical Hasson trocar and two additional 5 mm trocars on both sides. The non-dilated bowel loop was followed to locate the hernial orifice, which contained a loop of small intestine that was released, showing no signs of ischemia. The peritoneal flap was created, and with traction and counter-traction maneuvers, the hernial contents were reduced. A polypropylene mesh in plug form was placed, and the flap was closed with non-absorbable barbed material. Conclusions Due to the rarity and challenging diagnosis of obturator hernias, it is essential to consider them, especially in cases of intestinal obstruction in elderly women, particularly those without previous surgeries. Currently, the preferred treatment for repair is laparoscopic approach. Given the location of this hernia in the pelvis, laparoscopy allows clear visualization of the hernia contents and subsequent treatment, including assessing the viability of the incarcerated or strangulated intestine if present.