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Obturator hernia: A diagnostic challenge

Midori Tokushima, Hidetoshi Aihara, Masaki Tago, Motosuke Tomonaga, Yuta Sakanishi, Tsuneaki Yoshioka, Masaki Hyakutake, Itaru Kyoraku, Takashi Sugioka, Shu-ichi Yamashita

(Department of General Medicine, Saga University Hospital, Saga City, Japan)

Am J Case Rep 2014; 15:280-283

DOI: 10.12659/AJCR.890555

Background: Obturator hernia (OH) can be difficult to diagnose because it shows only nonspecific signs and symptoms. Although pain in a lower limb caused by compression of the obturator nerve by the hernia in the obturator canal (Howship-Romberg sign) is a characteristic sign, its presence is rather rare.
Case Report: We herein describe the case of a 90-year-old woman with an OH that was difficult to diagnose because of her slight abdominal signs and symptoms on admission and subtle abdominal computed tomography (CT) findings. Although the CT images revealed the presence of an OH, this finding was overlooked because it contained only a part of the small intestine wall, which is called the Richter type. Fortunately, her condition improved dramatically with only conservative treatment.
Conclusions: Although early diagnosis is essential to reduce morbidity and mortality, OH can be a diagnostic challenge even with abdominal CT.

Keywords: Geriatrics, Hernia - diagnosis, Ileus - diagnosis

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
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