A case of elderly male who had both obturator hernia and femoral hernia

We report a case of left obturator hernia in an elderly man who had undergone surgery for right femoral hernia two months earlier. A 76-year-old man referred with a diagnosis of bowel obstruction had the diagnosis confirmed by computed tomography (CT) with bowel obstruction due to an incarcerated right femoral hernia necessitating emergency surgery. His postoperative status was stable and he was discharged on POD 4. He returned with abdominal pain and vomiting 2 months after surgery. Emergency CT showed the small intestine incarcerated between the left pectineal muscle and left external obturator muscle. In emergency surgery under a diagnosis of bowel obstruction due to a left obturator hernia, we conducted Lennander's incision subcutaneous vascular grafts connecting the left axillary artery to the bilateral femoral artery after surgery for arteriosclerosis obliterans. Intraabdominal exploration showed that the ileum 40cm proximal from the ileocecal valve was incarcerated in the left obturator foramen. We pulled the ileum out carefully uninjured and found no signs of necrosis. The left obturator foramen was closed with Marlex mesh. Postoperative status was stable and he was discharged on 11 POD. CT is useful in elderly patients with bowel obstruction to ensure that an intraabdominal hernia difficult to determine from palpation alone is not overlooked.