Asian Journal of Case Reports in Surgery

Introduction: Obturator hernia (OH) is rare accounting for 0.05 – 0.4 % of all abdominal hernias. It is a diagnostic challenge because the signs and symptoms are non-specific. We report a case of OH which was diagnosed during laparoscopic left inguinal hernioplasty and is very rare because it occurred in male, on left side and with associated benign prostatic hypertrophy.

Case Report: Our patient 60 years old male, admitted with history of chronic lower abdominal pain, lump in left groin area which reduced in size after rest and aggravated on coughing and doing heavy work. On local examination, left inguinal hernia was present and was reducible. Patient was taken for laparoscopic transabdominal preperitoneal (TAPP) hernioplasty procedure. On laparoscopy after reducing the contents of inguinal hernia associated OH was seen.

Discussion: Loss of body fat and increase in intrabdominal pressure are the major factors that lead to the development of hernia. The commonest content of the sac is ileum with about 50% being of the Richter’s type. We suggest that laparoscopic hernia surgeries are superior to open methods. In open surgeries, we can only address direct and indirect inguinal hernia whereas during laparoscopy, we can find and treat direct, indirect, femoral and OH simultaneously. In our case, OH was detected incidentally, had it been open surgery this would have remain undiagnosed and lead to future morbidity.

Conclusion: OH is very rare and difficult to diagnose. Laparoscopic hernia surgeries can detect asymptotic OH and repair can be easily done either by simple suture closure or mesh placement. TAPP is procedure of choice for strangulated OH.