CASE REPORT ON OBSTRUCTED OBTURATOR RICHTER HERNIA MANAGED BY OPEN PREPERITONEAL MESH REPAIR

Introduction: Obturator hernia is rare abdominal hernia.It occurs when part of the pelvic contents protrude through the obturator foramen adjacent to Obturator vessels and nerve.It is a diagnostic challenge in the emergency department since the signs and symptoms are non-specific and the risk of strangulation is high in such hernias. It often occurs in elderly, emaciated and thin lean body mass women.The patient may present with intestinal obstruction with diffuse abdominal pain, nausea and vomiting and constipation,because of diagnostic difficulty they often present late and most of them are diagnosed introperatively. Case report: A 60 years old female patient presented to emergency General Surgery Department of GMERS Medical College Himmatnagar with pain in Right Groin region and diffuse pain abdomen and vomiting associated with constipation since 3 days,k/c/o Hypertension on medication Tab Amlodipine 5mg 1-0-0.On examination -Abdomen distended,tenderness present in Right groin region Abdominal girth 72 cm . Abdomen Xray revealed multiple air fluid levels ,USG Abdomen and pelvis suggestive of Right Groin Hernia and multiple dilated bowel loops with diameter of 3.5 mm suggestive of Intestinal Obstruction (Usg picture is uploaded in fig 2) and as patient was not affordable for CECT Abdomen and pelvis CECT Abdomen and pelvis was not done Discussion: Emergency lower midline exploratory laparotomy under General Anaesthesia was done and intraoperatively was diagnosed as Obstructed Obturator Hernia as the bowel was found to be protruding into Obturator foramen adjacent to Obturator vessels and Obturator nerve and the bowel was reduced from foramen and was found to be healthy ,single suture was taken over the coopers ligament and obturator foremen and peritoneum was closed as there was no bowel contamination preperitoneal space was created and 15X15 cm Macroporous light weight polypropylene Mesh was placed and fixed covering all the defects to prevent recurrence and any future groin and Inguinal hernia. Conclusion: Obturator Hernia is a rare form of abdominal hernia but can cause a severe Intestinal Obstruction if it not diagnosed and treated early bowel might result into ischemia and necrosis which can turn into a fatal complication.The elderly female with lean body mass and multiparous women presenting with diffuse pain abdomen and pain in Groin region with vomiting and constipation obstructed Obturator hernia and femoral hernia should always be kept as probable diagnosis.Radiological imaging may yield the diagnosis but in this case as patient was not affordable so ,CECT Abdomen with pelvis was not done and as patient Abdomen Xray had multiple air fluid levels .Emergency lower midline Exploratory laparotomy can be done and if obstructed bowel is found to be healthy then Preperitoneal mesh repair can be done and this procedure has got a good outcome increases the abdominal strength and has got a less recurrence chances.