Diagnosis of an obturator hernia by CT.

To cite: Nazarian S, Narayanan A, Chang S. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015212239 DESCRIPTION Obturator herniae are a rare type of abdominal wall herniae, with an incidence of 0.7–1%. They have a high mortality rate of up to 40% due to strangulation, and patients often present with nonspecific symptoms. The clinical presentation varies, depending on the contents of the hernial sac and the degree of herniation. High index of suspicion with rapid preoperative diagnosis is vital. A frail 81-year-old woman was admitted with a 72 h history of acute abdominal pain, absolute constipation and vomiting. She also reported pain and paraesthesia along the inner aspect of her right thigh (Howship-Romberg sign). She had never undergone abdominal or groin surgery. On examination, she had a distended abdomen with generalised tenderness and no groin hernias. Rectal examination and bloods were unremarkable. Plain X-rays revealed complete small bowel obstruction with no perforation. A high index of suspicion for an obturator hernia was raised. An urgent CT scan revealed an incarcerated right obturator hernia containing small bowel loop, confirming our clinical suspicion (figure 1). At laparotomy, a strangulated segment of small bowel was resected from the right obturator hernia defect and the defect was closed with PDS sutures. The patient made a good recovery. A high index of suspicion, radiological adjuncts and prompt intervention (operated within 6 h from presentation) were integral for better outcome. This case reiterates the importance of prompt recognition of obturator herniae. In the presence of bowel obstruction coupled with a positive Howship-Romberg sign, an obturator hernia must be considered.