Obstructing obturator hernia

Case contributed by Dr Craig Hacking

Presentation

Vomiting and abdominal pain.

Patient Data

Age: 90 years
Gender: Female
CT

Herniated loop of distal small bowel is seen extending through the left obturator foramen between the pectineus and obturator externus muscles. The herniated loop of bowel is surrounded by small amount of fluid. The small bowel proximal to this is fluid-filled and dilated measuring up to 36 mm. Normal small bowel mucosal enhancement is maintained.

1 cm fluid density lesion with tapering of the neck to the region of the bladder wall is seen running along medial to the right common femoral vein, this likely represents a small amount of peritoneal fluid within a direct inguinal hernia.

Fatty liver. Fatty atrophy of the pancreas with prominence of the pancreatic duct measuring at the upper limits of normal.

Subcentimetre hypodense renal lesions are unchanged in appearance. The spleen, adrenal glands, are unremarkable.

Small sliding hiatus hernia with dilated fluid-filled distal oesophagus. 10 mm fat density lesion in the region of pylorus in keeping with a lipoma.

Two large calcified pelvic masses in keeping with fibroids again noted with a smaller 1 cm calcified mass between the two unchanged in appearance and may reflect a smaller fibroid. By basal linear atelectasis.

Superior end plate fracture of L4 again noted.

Conclusion

Small bowel obstruction due to an incarcerated left obturator hernia.

Case Discussion

One of the less common sites for hernia to cause SBO.

Confirmed at surgery.

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Case information

rID: 34715
Case created: 6th Mar 2015
Last edited: 8th Sep 2017
Tag: hernia
Inclusion in quiz mode: Included

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