989 Obturator Hernia: A Rare Surgical Emergency

Abstract

Aim Obturator hernias are a rare pelvic hernia with an incidence of approximately 1%. These are more common in emaciated, elderly women and typically present with acute obstruction. Diagnosis can be challenging as clinical signs are non-specific and CT scan is the optimal imaging modality. Treatment is surgical and both open and laparoscopic methods have been demonstrated. We present a safe and effective approach to repair an acutely obstructed left sided obturator hernia using a laparoscopic Transabdominal preperitoneal (TAPP) technique. We aim to demonstrate the anatomical landmarks neighbouring an obturator hernia that require consideration for a safe repair. Method An 86-year-female presented with acute abdominal pain, vomiting and constipation. A CT scan confirmed an acutely obstructed left sided obturator hernia. Laparoscopy demonstrated small bowel herniating through the obturator canal in keeping with the transition point of obstruction. The hernia was reduced and small bowel viable. A pre-peritoneal flap was created and Prolene mesh placed to cover the defect. The pre-peritoneal flap was closed over the mesh and fixed in place using an absorbable strap fixation device. Care was taken to avoid injury to the obturator nerve and artery. Results The patient made an excellent recovery and was discharged at day five. They were followed up three months later and reported their long-term intermittent symptoms of obstruction were cured after surgery. Conclusions Obturator hernias are a rare presentation to the emergency general surgical take. They can cause diagnostic uncertainty and an operative challenge. Laparoscopic TAPP repair is a safe and effective approach for obturator hernias.