Delayed Small Bowel Perforation after Noninvasive Reduction of an Incarcerated Obturator Hernia

Abstract

An 85-year-old woman with a chief complaint of persistent abdominal pain and vomiting visited a clinic where she underwent computed tomography (CT). A diagnosis of right incarcerated obturator hernia was made, and she was referred to our hospital. The hernia could be easily reduced manually (noninvasively). An immediate CT scan confirmed the hernia reduction and showed no findings suggestive of gastrointestinal perforation or any other conditions. Three days after the hernia reduction, the patient complained of abdominal pain. A CT scan revealed intraperitoneal free gas, which led to a diagnosis of perforation peritonitis. The patient underwent open partial small bowel resection with preperitoneal hernia repair via midline incision using a Direct Kugel Patch with measures taken to prevent wound contamination. Noninvasive reduction of incarcerated obturator hernia has the benefits of avoiding emergency surgery and allowing preoperative detailed evaluation. However, there is always a risk of ischemic perforation of the incarcerated bowel during the reduction. Thus, no consensus has been reached regarding the indication of the noninvasive reduction. Prior to this case report, there have been no documented cases of delayed bowel perforation after noninvasive reduction of incarcerated obturator hernia in the scientific literature. We further discuss this case by reviewing the literature.