LAUSR

Obturator hernia is a very rare type of abdominal wall hernia, accounting for less than 1% of all abdominal wall hernias. They can be confused with femoral hernias as well as they can arise simultaneously, just like in this clinical case. A 82 year old female, with multiple comorbidities including a right inguinal hernioplasty, was brought to our emergency department complaining of abdominal pain, distension and vomiting in the last 24 hours. On physical examination, there where abnormally active, high-pitched bowel sounds, abdominal distension and pain on left lower quadrant but no tenderness. Palpation of groin area showed an incarcerated left femoral hernia, apparently containing only omentum. As the patient maintained left lower abdominal pain, we proceed to a CT scan, which demonstrated small bowel dilation with air-fluid levels consistent with a small bowel obstruction originating from an obturator hernia. Open tension-free mesh repair of femoral hernia was done and no need for ressection since it only contained omentum, without ischemic signs. Open transperitoneal nonmesh repair of obturator hernia was performed after hernia reduction. There was no irreversible ischemia. Evolution during hospitalization was uneventful. Regarding obturator hernias, there is no optimal approach since it is a very rare type of hernia, so it probably depends on patient condition and surgeon experience. A transperitoneal approach is preferred when there's signs of bowel obstruction, as we proceed on this clinical case.