Perforated obturator Littre hernia.

A 75-year-old woman presented with a 5-day history of abdominal pain, constipation and vomiting. Her symptoms followed acute gastroenteritis, which was managed conservatively at another centre. She was also experiencing obscure pain in her right knee. On examination, her body mass index was 16, and she was dehydrated. Abdominal examination revealed central distention with visible bowel coils. There were no signs of peritonism, but bowel sounds were absent. External hernial sites were normal. Pelvic examination revealed a full-thickness rectal prolapse and complete uterine procidentia. Her total white blood cell count was 13.4 × 109/L, and her serum albumin level was 5 g/L. A contrast-enhanced spiral computed tomography (CT) scan of the abdomen confirmed the plain abdominal radiographic finding of dilated small bowel loops in addition to an abrupt termination at the terminal ileum. With a working diagnosis of acute small bowel obstruction, the patient underwent laparotomy pending a final report by the senior radiologist (Fig. 1). Laparotomy revealed a perforated Meckel diverticulum herniating into the obturator canal. The neck of the hernia formed a ring of constriction at the base of the diverticulum where it had perforated (Fig. 2). In view of the