Early CT-Based Diagnosis and Surgical Management of a Strangulated but Viable Obturator Hernia: A Case Report and Literature Review

Abstract

Introduction: Obturator hernia is a rare pelvic hernia, accounting for less than 1% of all abdominal wall hernias (1,2). It predominantly affects elderly, thin, multiparous women and often presents as small bowel obstruction with high morbidity and mortality due to delayed diagnosis (3,4). We report a case of a strangulated obturator hernia without bowel necrosis, successfully managed by simple reduction and defect closure. Presentation of Case: A 79-year-old female presented with acute small bowel obstruction. CT scan revealed a right obturator hernia containing a viable ileal loop. Emergency laparotomy confirmed a strangulated but viable bowel. The herniated loop was reduced, and the obturator defect was closed with non-absorbable sutures. No bowel resection was required. Postoperative recovery was uneventful. Discussion: CT imaging is the diagnostic gold standard, enabling early recognition, assessment of bowel viability, and surgical planning. In emergency settings, the open transperitoneal approach provides optimal exposure for bowel evaluation and safe repair, particularly in elderly patients or when strangulation is suspected. Conclusion: Obturator hernia should be suspected in elderly, emaciated, multiparous women presenting with intestinal obstruction and no palpable hernia. Early CT-based diagnosis and timely surgery prevent bowel necrosis and improve outcomes (9–11).