Abstract
A 79-year-old woman consulted a physician complaining of abdominal pain and vomiting. Although the patient was diagnosed as having ileus and was treated with conservative therapy for five days, she was brought to our hospital because her symptoms had not improved. The patient had a past history of laparotomy under a diagnosis of left obturator hernia a year and nine months previously, and she had suffered from a cerebral infarction three months previously and had been hospitalized for two months. CT revealed a round mass between the right pectineal and obturator externus muscles, and the patient was diagnosed as having a right incarcerated obturator hernia. A laparotomy was conducted, which revealed that the ileum was incarcerated into the right obturator canal. The incarcerated ileum was not perforated but necrotic, and partial resection of the ileum was performed. The hernial orifice was extended to 1.7 centimeters, and was closed with the mesh-plug method. The postoperative course was uneventful without infection of the mesh or the compression symptom due to the plug inserted into the right obturator canal, and the patient was discharged on postoperative day 17. In the treatment of patients diagnosed as having ileus who have a past history of obturator hernia, we must take the possibility of a metachronous bilateral obturator hernia into consideration, and early diagnosis is important.
