Abstract
An 82-year-old female with autosomal dominant polycystic kidney disease (ADPKD) who had received hemodialysis therapy for 14 years is reported. She experienced pain in the right leg on walking and eventually became bed-ridden. She consulted our emergency room for severe nausea and epigastralgia and vomitted blood. Since she was diagnosed as having severe gastroesophageal reflux disease by endoscopic examination and concomitant pneumonia of the inferior lobe of left lung by chest X-ray finding, she was admitted to our hospital. When both diseases were considered recovered, she was allowed to start ingestion again on the 7 th day after the admission. On the next day, she complained of recurrent abdominal pain, and she was diagnosed as having a small intestinal ileus. Oral intake was stopped and an ileus tube was inserted immediately. She developed pyrexia and hypotension on the 10th day and died due to sepsis on the 11th day. We obtained consent for an autopsy from her family on the day of death. Autopsy demonstrated that part of the ileum 30 cm oral from the ileocecal portion was completely impacted in the right obturator foramen. Therefore, we diagnosed that ileus was induced by obturator hernia. In general, an obturator hernia is thought to be rare as a cause of ileus and is not familiar to physicians. There was no erosion, ulcer or necrosis in the incarcerated intestine on autopsy performed on the day of death. Even in the early stage before necrosis has occurred in the incarcerated intestine, the obturator hernia could induce serious complications such as sepsis particularly in immunocompromised hosts. We conclude that we should not overlook obturator hernia and should consider surgery when we encounter a dialysis patient with ileus.
