Left sided Richter type obturator hernia causing intestinal obstruction: A case report

Introduction

Although relatively rare, an obturator hernia is a significant cause of intestinal obstruction. It usually occurs in emaciated elderly females. Computed tomography is the imaging modality of choice to diagnose obturator hernias.

Case report

In this report we present a case of an elderly female who presented to the emergency department with features suggesting bowel obstruction. The patient was admitted to the hospital and was initially managed conservatively. Two days later the patient underwent an exploratory laparotomy and was diagnosed with a left sided Richter type obturator hernia. The hernia was successfully reduced and the necrotic bowel was resected with end to end anastomosis.

Discussion

An obturator hernia is a rare type of abdominal hernias which often occurs in very thin old females. Patients with obturator hernias usually present with symptoms of acute or intermittent small bowel obstruction. Mild symptoms without abdominal pain may be due to incomplete obstruction or Richter type hernia. Computed tomography is considered the gold standard diagnostic modality for obturator hernias. An early surgical intervention is the treatment of choice.

Conclusion

The clinical diagnosis of an obturator hernia is often difficult due to its nonspecific symptoms and infrequent signs. Yet early diagnosis is mandatory because its delay contributes to bowel necrosis and to the poor prognosis in these patients. Surgery remains the only effective management of this condition.

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Obturator hernias are a rare cause of intestinal obstruction.

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An obturator hernia usually occurs in very thin elderly females.

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Obturator hernias present with symptoms of intestinal obstruction.

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Computed tomography is the imaging modality of choice to diagnose obturator hernias.

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The only management of this condition is surgery through either laparotomy or laparoscopy.

Acute single appendicitis in a female with a duplicated appendix

Appendiceal duplication is a rare congenital anomaly with an estimated incidence ranging from 0.004 to 0.009%. Preoperative diagnosis of a duplicated appendix is often difficult and is usually done intraoperatively. Histopathological examination of the surgical specimen is mandatory to confirm the presence of two appendices. In this case we report a female patient with acute inflammation in one of her two appendices. Surgeons should always bear in mind this rare anomaly to avoid serious ethical and legal consequences.