Obturator hernia as a cause of small bowel obstruction in an 80-year-old female patient with comorbidities: management and challenges in a resource-limited setting: a case report

Abstract

Abstract Background Obturator hernia is one of the rarest types of hernia and accounts for only a small percentage of small bowel obstructions. It may be asymptomatic, but most patients present with acute intestinal obstruction. Some patients may also report pain along the medial aspect of the thigh due to compression of the obturator nerve. The clinical presentation of obturator hernia is often non-specific, which makes diagnosis challenging. Imaging modalities such as ultrasonography, herniography, and computed tomography (CT) of the abdomen can aid in diagnosis. Although non-surgical management has been described in the literature, it is frequently associated with high morbidity and mortality. Surgical intervention remains the treatment of choice. Case presentation An 80-year-old female patient presented with crampy periumbilical abdominal pain of one week’s duration. She also reported one to two episodes of vomiting per day for five days, consisting of ingested material, associated with failure to pass feces and flatus. She had progressive abdominal distension for four days. Further history revealed a two-week history of high-grade intermittent fever and productive cough with whitish sputum. On examination, she was in severe abdominal pain and tachycardic, with a pulse rate of 124 beats per minute and an irregularly irregular rhythm. Abdominal examination revealed visible peristalsis. Investigations, including serology and radiologic imaging, were performed. Plain abdominal radiography showed signs of small bowel obstruction, while chest X-ray revealed pneumonia. Electrocardiography demonstrated atrial fibrillation, and echocardiography showed valvular degeneration. The findings were discussed with the patient and her family, and they opted for surgical intervention. After obtaining informed consent, laparotomy was performed. Intraoperatively, a small bowel loop approximately 50 cm from the ileocecal valve was found herniated through the obturator foramen. A 1 × 2 cm defect was noted on the antimesenteric side of the herniated bowel segment. Repair and anastomosis were performed, and the patient left the operating room with stable vital signs. She remained hospitalized for six days postoperatively and was subsequently discharged with outpatient follow-up. Follow-up visits were uneventful, with significant clinical improvement. Conclusion Although obturator hernia is a rare cause of small bowel obstruction, it should be considered in the differential diagnosis of elderly female patients. Maintaining a high index of suspicion facilitates early diagnosis and timely management, as delayed recognition is associated with increased morbidity and mortality.