Obturator hernia: A case report of intestinal obstruction with challenging diagnosis and non-standardized treatment

INTRODUCTION AND IMPORTANCE: Obturator Hernia (OH) is a rare clinical entity that constitue less than 1% of all abdominal hernias. It happens in elderly thin women malnourished. The diagnosis is usually delayed because symptoms are non-specific, and patients commonly have features of intestinal obstruction. There are no international guidelines for treatment and the best surgical approach still unknown. CASE PRESENTATION: We report a case of strangulated OH in a 75 year woman who consulted in our service for an acute intestinal obstruction. Intra-operatively findings showed loop of ileum entering through a defect in the right obturator canal. The obturator defect was closed by approximation flap of peritoneum and covered by right ovair and fallopian tube. CLINICAL DISCUSSION: This case is reported because of its an uncommon type of abdominal wall hernia with high probability of bowel strangulation and highest morbidity and mortality rates. There are no international guidelines for treatment and the best surgical approach still unknown. CONCLUSION: The diagnosis of OH should be suspected every time there is an intestinal obstruction of unknown origin in emaciated elderly women. Open or laparoscopic sutured repair surgery and placement of mesh remain the most common method of repair.