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n n I g http://dx.doi.org/10.4172/2376-0249.1000476 ISSN: 2376-0249 Clinical & Medical Imaging

Clinical Image

Small Intestine Obstruction Secondary to Obturator Hernia Cheng-Chieh Yen1* and Chi-Jen Chen2 1Department of Internal Medicine, Ditmansion Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan 2Chia-Yi Hospital, Ministry of Health and Welfare, Taiwan

Figure 1: (a) KUB radiography revealed small intestinal obstruction of coiled spring sign. (b) Herniated ileum (arrow head) was noted between right pectineus muscle and obturator externus muscle (arrows).

An 84-year-old lady presented with a 3-day history of abdominal distention and intermittent colic. She was underweight (body mass index of 12 Kg/m2) and received adhesiolysis for ileus several years ago. Physical examination revealed diminished distal bowel sound and intermittent throbbing pain of right groin area. The kidney, ureter and bladder (KUB) radiography demonstrated small intestine obstruction (Figure 1a). Symptoms persisted despite of prokinetic agents and enema. Abdominal computed tomography (CT) disclosed bowel segment between right pectineus muscle and obturator externus muscle (Figure 1b). Mechanical small intestine obstruction secondary to right obturator hernia was diagnosed, and symptoms relieved after segmental resection of incarcerated ileum via laparoscopy. Intestinal obstruction can be functional or mechanical. Etiologies of mechanical obstruction include postoperative adhesions, hernias, tumors, gallstones, intussusceptions, etc. Obturator hernia, a rare hernia type, is abdominal contents protruding through the obturator foramen. It is more common in the elderly and debilitated woman, also named the “little old lady’s hernia”. Once the diagnosis was available during intestinal obstruction exploration due to lack of specific physical examination, and now it could be detected early and correctly before operation with the assistance of CT, which typically showed herniated segment between pectineus and obturator muscle. Surgical intervention is the most proper treatment option. In typical patients with intestinal obstruction of unknown origin, image studies such as abdominal or pelvis CT should be considered for obturator hernia.

*Corresponding author: Cheng-Chieh Yen, Department of Internal Medicine, Ditmansion Medical Foundation Chia-Yi Christian Hospital, No.539, Zhongxiao Rd., East Dist, Chia-Yi City, 60002, Taiwan; Tel: +88652765041; E-mail: [email protected] Citation: Yen CC, Chen CJ (2016) Small Intestine Obstruction Secondary to Obturator Hernia. Int J Clin Med Imaging 3: 476. doi:10.4172/2376- 0249.1000476 Copyright: © 2016 Yen CC, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.