Rare case of intermittent obturator hernia mimicking ureteric colic - a report
Dr Matheesha Herath and Harsh Kanhere from the Royal Adelaide Hospital, Adelaide, Australia recently reported a case study of an intermittent obturator hernia mimicking ureteric colic in which they noted that laparoscopic intervention is safe and effective approach for emergency management of symptomatic obturator hernia.
The study is published in the International Journal of Surgery Case Reports.
Obturator hernia is a very rare surgical pathology representing between 0.05% and 1.4% of all herniae. It typically occurs in thin, multiparous, elderly females and is suspected to be due to the laxity of pelvic floor muscles. It can cause significant diagnostic challenges due to a lack of reliable clinical examination signs. Presentations can have a variety of features and it is a diagnosis that needs to be considered – especially in elderly multiparous women.
Obturator hernia is an uncommon condition and can have a varied presentation. A comprehensive review of the literature demonstrates the difficulty in making an accurate diagnosis. The open intervention was the initial gold standard of treatment but there is a growing body of evidence advocating for the use of laparoscopy in an emergency setting.
Hence, the authors studied a 76-year-old multiparous female with an exceptionally rare surgical issue. She presented to the Emergency Department (ED) with transient episodes of severe loin to groin pain. Imaging Computer Tomography (CT) initially demonstrated mild left hydronephrosis and she underwent an unremarkable ureteroscopy and stenting. Following stent removal, she continued to have recurrent episodes of pain. She presented to the ED with one such episode. A repeat CT scan was performed, and this demonstrated an obturator hernia with partial small bowel obstruction. She underwent a laparoscopy by which time the hernia had reduced, and her pain had settled. Laparoscopy revealed bilateral obturator herniae with the one on left larger than the right. Both were repaired laparoscopically, and she made an uneventful recovery.
Therefore, the researchers concluded that "early diagnostic imaging with CT while a patient is symptomatic can aid in making an accurate diagnosis. Laparoscopic repair can be safely used with good outcome in the context of an incarcerated obturator hernia."
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