Rare Case of Peritonitis due to Ileal Perforation Secondary to Richter’s Type of Obturator Hernia

Abstract

Obturator hernia is an extremely rare condition accounting for almost 0.07%-1% of all abdominal wall hernias, usually occurring in the elderly and emaciated females with a history of previous abdominal surgery. The symptoms of this particular hernia are non-specific; therefore, a high index of clinical suspicion should always be made. This rare condition may lead to acute small intestinal obstruction. The pre-operative diagnosis is challenging and often misleading on occasions, especially in co-morbid cases. This leads to delayed diagnosis and surgical intervention, hence causing an increased morbidity and mortality rate. The computed tomography (CT) scan of the abdomen and pelvis is the gold standard for diagnosis. We present a case of an 80-year-old female, with known comorbid of hypertension, initially diagnosed as peritonitis and on further examination revealed strangulated obturator hernia with proximal perforation, that underwent lower midline laparotomy with resection of necrotic bowel, an end-to-end anastomosis, and repair of the defect by vicryl suture.

Small Bowel Obstruction Due to Incarcerated Obturator Hernia: Successfull Surgical Management with Modified Mesh-Plug Hernioplasty

“…The obturator canal is about 3 cm long and 1 cm wide [ 7 ] and it is a passage formed in the obturator foramen by part of the obturator membrane and the pelvis. Obturator foramen results from the fusion of the ischial and pubic bones [ 5 ] ( Figure 5 ). Obturator hernia develops by the loosening of pelvic floor muscle and absence of preperitoneal fat and lymphatic tissue, which usually envelops the obturator canal [ 5 ].…”

“…Obturator hernia is an uncommon subtype of hernia of the abdominal wall, representing about 0.07–1% of all abdominal wall hernias [ 1 – 5 ]. Its incarceration is a rare cause of mechanical intestinal obstruction (0.2–1.6%) [ 3 , 4 ].…”

“…Its incarceration is a rare cause of mechanical intestinal obstruction (0.2–1.6%) [ 3 , 4 ]. Obturator hernias have a higher incidence in elderly women (70–90%) [ 1 – 8 ] from Asian countries [ 4 , 5 ] and those who are malnourished [ 1 , 2 , 4 – 7 ] or multiparous [ 2 , 5 , 6 ]. This type of hernia has the highest morbidity and mortality rates of all abdominal wall hernias, with 70% mortality in complicated cases [ 1 , 5 , 7 ].…”

“…Obturator hernias have a higher incidence in elderly women (70–90%) [ 1 – 8 ] from Asian countries [ 4 , 5 ] and those who are malnourished [ 1 , 2 , 4 – 7 ] or multiparous [ 2 , 5 , 6 ]. This type of hernia has the highest morbidity and mortality rates of all abdominal wall hernias, with 70% mortality in complicated cases [ 1 , 5 , 7 ]. The hernia sac usually contains the small intestine; however, it may rarely contain the appendix, colon, Meckel’s diverticulum, or epiploon [ 2 , 6 ].…”

“…The hernia sac usually contains the small intestine; however, it may rarely contain the appendix, colon, Meckel’s diverticulum, or epiploon [ 2 , 6 ]. Obturator hernia diagnosis is challenging due to its rarity and its signs and symptoms being often unspecific, leading to a delay in diagnosis and treatment [ 1 – 3 , 5 , 7 ]. Surgical repair is the standard treatment for this condition, and multiple approaches have been described [ 1 – 8 ].…”