Abdominal Pain, Flatus
Case History: 60-year-old male with complaints of inability to pass stool and flatus with pain in abdomen.
Case History: 60-year-old male presented to emergency room with complaints of inability to pass stool and flatus for two days, associated with pain in abdomen for four days.On examination, abdomen was tense distended, associated with guarding and rigidity.
On examination, abdomen was tense distended, associated with guarding and rigidity.
Figure 1. Axial section of CECT showing herniated bowel loop (white arrow) lies in between pectineus muscle anteriorly and obturator muscle posteriorly on right side.
Figure 2. Coronal section of CECT showing herniated bowel loop on right side.
Figure 3. Axial and coronal section on CECT showing dilated fluid- and gas-filled bowel loops (yellow arrow) and collapsed distal loops with positive rectal contrast within them (yellow arrowhead).
Figure 4. Intra-operative image of bowel loop retrieved from obturator foramen on right side, the retrieved bowel loop appears necrotic (black arrow).
Figure 5. Intra-operative image showing anastomosis of ileal loops after resection of gangrenous part of bowel.
Figure 6. Intra-operative image of hernia repair by mesh placement.
Diagnosis: Obturator hernia on right side
Patient recovered from the bowel obstruction, passing stool spontaneously seven days after the laprotomy.
Obturator hernia is difficult to diagnose clinically because it has an uncommon incidence.
Contrast-enhanced CT is the investigation of choice in diagnosing obturator hernia.
About one-third of these patients develop a syndrome of thigh neuralgia due to the compression of the obturator nerve in the obturator canal.
