Perforated obturator Littre hernia

Department of Surgery Unit 1, General and Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
Canadian journal of surgery. Journal canadien de chirurgie (Impact Factor: 1.51). 07/2009; 52(3):E77-8.
Source: PubMed


Meckel diverticulum and obturator hernia are rare causes of intestinal obstruction. We present the unique case of an elderly woman with acute abdomen secondary to the coexistence of both these conditions.

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    ABSTRACT: Introduction Incarcerated obturator hernia is a rare cause of bowel obstruction. This case report aimed to review the diagnosis and management of obturator hernia by describing the anatomy, clinical presentation, diagnostic modalities, and predisposing factors. Case presentation A 49-year-old woman presented to emergency department with progressive spastic abdominal pain, vomiting, abdomen enlargement, and tenesmus. One month before this episode she was diagnosed a carcinoma of the cervix uteri which was defined as T1b N1 M0 G2. She has undergone a curative R0 type surgery and adjuvant chemoradiation. There were no pelvic abnormalities described in the operative protocol. She lost 20 kg in two years. Because of ineffective conservative treatment, progression of acute bowel obstruction and signs of local peritonitis, she underwent an urgent curative laparotomy. It was confirmed that a loop of ileum was incarcerated and irreducible in the canal of right side of pelvis that suited to obturatoric foramen. Conclusions Rarity of such a condition makes great difficulties in diagnosing it. CT is needed to recognize obturator hernia in early stages before its incarceration. Significant lost weight (> 20 kg), and adjuvant chemoradiotherapy were most possible predisposing risk factors for right obturator hernia in 49 years old female.
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    ABSTRACT: A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h. The pain localized over the periumbilical area with radiation along the medial side of the thigh. Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal. Incarcerated obturator hernia was diagnosed and emergency laparotomy was arranged immediately. Unfortunately, her family refused surgery because of her worsening condition. On the third evening after admission, the patient developed peritonitis and sepsis. Perforation of small bowel due to the incarceration was noted during laparotomy. Bowel resection and an end-ileostomy were performed. She recovered well despite of the complication of multiple organ dysfunction syndrome. Literature is reviewed, and the pathogenesis, clinical manifestation, imaging features and treatment are discussed.
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