Presentation
Presenting through ER with abdominal pain and distended abdomen on physical examination to rule out intestinal obstruction.
Patient Data
The stomach and small bowel loops are dilated and filled with contrast, with transition point seen at the left side of the pelvis, where the small bowel is seen passing between the obturator internus and externus muscles then lying underneath the pectineus muscle with surrounding free fluid suggesting incarcerated left obturator hernia.
Free gas pockets are seen at the right iliac fossa surrounding the small bowel loops and underneath the abdominal wall suggestive of localized bowel perforation.
No evidence of abdominal or pelvis masses, gross lymph node enlargement, or fluid collections.
The gallbladder appears distended with enhancing wall but without evidence of calcified stones or pericholecystic fluid.
Case Discussion
This is a very rare and interesting case, that usually occurs in elder women. This case illustrates a hernial sac between the obturator and the pectineus muscles. Its location may mimic a necrotic lymph node.
Unable to process the form. Check for errors and try again.