Little Old Lady’s Hernia: A Rare Cause of Intestinal Obstruction

Obturator hernia is a rare type of pelvic hernia which generally occurs in elderly patients with accompanying diseases. Because it is difficult to diagnose before surgery ,the morbidity and mortality rates are high. The most common clinical presentation is intestinal obstruction with or without features of strangulation. We operated a case of 60 year old, multiparous, female patient admitted in the emergency with 5 days history of abdominal pain, abdominal distension, nausea, vomiting, constipation & inability to pass flatus. On examination abdomen was distended but soft with few visible loops and increased peristaltic bowel sounds. Her lab investigation were normal. X –ray FPA upright revealed multiple gas fluid levels. Her CT showed a small bowel loop herniating through obturator foramen and proximal small bowel dilatation. On operation a small bowel loop was found to be herniated through obturator foramen and on reduction of hernia the herniated loop was found to be gangrenous. So, resection anastomosis was done and obturator foramen was closed with primary sutures. Post operative period was uneventful. In conclusion obturator hernia must be considered in the differential diagnosis of thin elderly patients, especially females admitted with symptoms of intestinal obstruction and immediate CT must be done to prevent gangrenous changes.