Abstract
We report a case of obturator hernia, presenting only with right knee pain and appetite loss. An 85-year-old woman with a history of gastrectomy and cholecystectomy presented with right knee pain with repeated episodes of remissions and exacerbations. She developed fever and hypoxemia, but had no abdominal symptoms. Although we suspected orthopedic diseases, abdominal ultrasonography for appetite loss revealed the keyboard and to-and-fro signs. Contrast-enhanced abdominal computed tomography revealed small bowel obstruction due to right obturator hernia and aspiration pneumonia owing to esophageal regurgitation. Therefore, 4 hours after admission, an emergency repair of obturator hernia was performed via the inguinal approach. The obstructed bowel was not necrotic, and therefore, the bowel was not resected. After surgery, the right knee pain disappeared completely, and she was discharged. Obturator hernia is observed mostly in thin, elderly, and multiparous women, and rarely presents without abdominal symptoms. Occasionally, a radiating pain from the thigh to the knee caused by obturator nerve compression (Howship-Romberg sign) may be observed, which may be overlooked. When thin elderly women with appetite or weight loss complain of lower limb pain, obturator hernia should be considered and diagnosed as early as possible with abdominal ultrasonography and computed tomography.
