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Bilateral obturator hernia diagnosed by computed tomography: a case report with review of the literature.

Khaladkar SM, Kamal A, Garg S, Kamal V - Radiol Res Pract (2014)

Bottom Line: Its diagnosis is often delayed with resultant increased morbidity and mortality due to bowel ischemia/gangrene.USG showed small bowel obstruction and an obstructed left sided femoral hernia.Early diagnosis and surgical treatment contribute greatly in reducing the morbidity and mortality rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Radio-Diagnosis, Dr. D.Y. Patil Medical College, Pimpri, Pune 411018, India.

ABSTRACT
Obturator hernia is a rare form of abdominal hernia and a diagnostic challenge. It is commonly seen in elderly thin females. Its diagnosis is often delayed with resultant increased morbidity and mortality due to bowel ischemia/gangrene. It is mistakenly diagnosed as femoral or inguinal hernia on USG. Computed tomography is diagnostic and is a valuable tool for preoperative diagnosis. This report presents a case of 70-year-old thin female presenting with intestinal obstruction due to left sided obstructed obturator hernia. USG showed small bowel obstruction and an obstructed left sided femoral hernia. CT scan of abdomen and pelvis with inguinal and upper thigh region disclosed left sided obturator hernia. It also detected clinically occult right sided obturator hernia. Early diagnosis and surgical treatment contribute greatly in reducing the morbidity and mortality rate.

No MeSH data available.


Related in: MedlinePlus

X-ray standing abdomen showing dilated small bowel loops in lower abdomen and pelvis.
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fig1: X-ray standing abdomen showing dilated small bowel loops in lower abdomen and pelvis.

Mentions: 70-year-old known hypertensive female patient presented with intermittent abdominal pain and vomiting for 2 days. She gave past history of pulmonary Koch's 10 years back for which she completed AKT. On examination the patient was thin-built, conscious, and well oriented. Blood pressure was 150/90 mmHg. Respiratory rate was 22/min. Per abdomen examination showed mild abdominal distension. She was referred for USG Abdomen and Pelvis. USG Abdomen and Pelvis showed mild dilatation of small bowel loops in entire abdomen (caliber = 3–3.5 cm) with intermittent to-and-fro peristalsis. Mild free fluid was noted in pelvis and in between small bowel loops. Left inguinal and left upper thigh region showed a herniated small bowel loop extending in medial aspect of upper thigh which was irreducible. A diagnosis of obstructed and irreducible left femoral hernia was made. X-ray standing abdomen (Figure 1) revealed dilated small bowel loops in mid and lower abdomen with no pneumoperitoneum. She was referred for emergency plain CT scan of abdomen and pelvis. Small bowel loops in abdomen and pelvis appeared fluid-filled and dilated of caliber 3–3.5 cms (Figures 2(a) and 2(b)). There was herniation of a bowel loop of length 3.5 cm through left obturator foramen extending inferiorly between pectineus muscle anteriorly and obturator externus muscle posteriorly, suggestive of obturator hernia (Figures 3, 4(a), and 4(b)). Left pectineus muscle was compressed and displaced anteriorly. Few small bowel loops appeared collapsed; hence obstruction was likely to be at distal jejunum/proximal ileal level. Visualized colon appeared collapsed. Also, hernia of omentum/mesentery was noted from the right obturator foramen measuring approximately 2 × 0.9 cm. Herniated omentum/mesentery was seen to lie in between the pectineus muscle anteriorly and obturator externus muscle posteriorly (Figures 4(a) and 4(b)). No herniated bowel loop was seen through right obturator foramen in the present study. A diagnosis of obstructed left obturator hernia with proximal dilatation of small bowel loops and right obturator hernia containing omentum/mesentery was made.


Bilateral obturator hernia diagnosed by computed tomography: a case report with review of the literature.

Khaladkar SM, Kamal A, Garg S, Kamal V - Radiol Res Pract (2014)

X-ray standing abdomen showing dilated small bowel loops in lower abdomen and pelvis.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4269088&req=5

fig1: X-ray standing abdomen showing dilated small bowel loops in lower abdomen and pelvis.
Mentions: 70-year-old known hypertensive female patient presented with intermittent abdominal pain and vomiting for 2 days. She gave past history of pulmonary Koch's 10 years back for which she completed AKT. On examination the patient was thin-built, conscious, and well oriented. Blood pressure was 150/90 mmHg. Respiratory rate was 22/min. Per abdomen examination showed mild abdominal distension. She was referred for USG Abdomen and Pelvis. USG Abdomen and Pelvis showed mild dilatation of small bowel loops in entire abdomen (caliber = 3–3.5 cm) with intermittent to-and-fro peristalsis. Mild free fluid was noted in pelvis and in between small bowel loops. Left inguinal and left upper thigh region showed a herniated small bowel loop extending in medial aspect of upper thigh which was irreducible. A diagnosis of obstructed and irreducible left femoral hernia was made. X-ray standing abdomen (Figure 1) revealed dilated small bowel loops in mid and lower abdomen with no pneumoperitoneum. She was referred for emergency plain CT scan of abdomen and pelvis. Small bowel loops in abdomen and pelvis appeared fluid-filled and dilated of caliber 3–3.5 cms (Figures 2(a) and 2(b)). There was herniation of a bowel loop of length 3.5 cm through left obturator foramen extending inferiorly between pectineus muscle anteriorly and obturator externus muscle posteriorly, suggestive of obturator hernia (Figures 3, 4(a), and 4(b)). Left pectineus muscle was compressed and displaced anteriorly. Few small bowel loops appeared collapsed; hence obstruction was likely to be at distal jejunum/proximal ileal level. Visualized colon appeared collapsed. Also, hernia of omentum/mesentery was noted from the right obturator foramen measuring approximately 2 × 0.9 cm. Herniated omentum/mesentery was seen to lie in between the pectineus muscle anteriorly and obturator externus muscle posteriorly (Figures 4(a) and 4(b)). No herniated bowel loop was seen through right obturator foramen in the present study. A diagnosis of obstructed left obturator hernia with proximal dilatation of small bowel loops and right obturator hernia containing omentum/mesentery was made.

Bottom Line: Its diagnosis is often delayed with resultant increased morbidity and mortality due to bowel ischemia/gangrene.USG showed small bowel obstruction and an obstructed left sided femoral hernia.Early diagnosis and surgical treatment contribute greatly in reducing the morbidity and mortality rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Radio-Diagnosis, Dr. D.Y. Patil Medical College, Pimpri, Pune 411018, India.

ABSTRACT
Obturator hernia is a rare form of abdominal hernia and a diagnostic challenge. It is commonly seen in elderly thin females. Its diagnosis is often delayed with resultant increased morbidity and mortality due to bowel ischemia/gangrene. It is mistakenly diagnosed as femoral or inguinal hernia on USG. Computed tomography is diagnostic and is a valuable tool for preoperative diagnosis. This report presents a case of 70-year-old thin female presenting with intestinal obstruction due to left sided obstructed obturator hernia. USG showed small bowel obstruction and an obstructed left sided femoral hernia. CT scan of abdomen and pelvis with inguinal and upper thigh region disclosed left sided obturator hernia. It also detected clinically occult right sided obturator hernia. Early diagnosis and surgical treatment contribute greatly in reducing the morbidity and mortality rate.

No MeSH data available.


Related in: MedlinePlus