A Case of End-stage Cervical Cancer Complicated by Obturator Hernia That Was Difficult to Differentiate from Neuropathic Pain Due to Recurrent Pelvic Cancer

Abstract

Herein, we report our experience of a patient whose recurrent pelvic cancer was complicated by obturator hernia after cervical cancer surgery. Regardless of the type of carcinoma, recurrent pelvic cancer tends to be complicated by neuropathic pain. On the other hand, obturator hernia is also often complicated by the similar neuropathic pain, which is referred to as Howship-Romberg symptom. However, it is relatively a rare disease that is considered difficult to make a diagnosis. In the case of this report, the patient had already developed neuropathic pain in the inside of the left thigh when she was admitted to our hospital, and began to develop a similar symptom on the right side during the course of follow-up. Despite the additional administration of analgesic adjuvant, the pain in the right thigh did not improve, and she began to develop heat sensation and redness in the extensive area from the thigh to the knee. CT scan revealed subcutaneous emphysema image and abscess formation. Based on the results of the examination, the patient’s right thigh was diagnosed as caused by the digestive tract incarcerated by obturator hernia rupturing into the right limb. The differentiation of obturator hernia is difficult to make, but its early stage diagnosis might make it possible to evade the aggravation of the symptom by manual reposition. In conclusion, when recurrent pelvic cancer was found to be complicated by neuropathic pain, it is critical to make an appropriate diagnosis taking into account the potential obturator hernia at an early stage.