Emergency incarcerated "little old lady's hernia": a case report and review of the literature.

Introduction and importance: An obturator hernia (OH) is an uncommon type of pelvic hernia that typically presents as a bowel obstruction. It occurs when a portion of the intestine, most commonly the ileum, herniates through the obturator foramen in the pelvic wall. Case presentation: A 76-year-old woman with a known history of Tako-Tsubo cardiomyopathy and chronic obstructive pulmonary disease presented with a 2-day history of acute abdominal pain, vomiting, and abdominal bloating. On physical examination, she exhibited diffuse abdominal tenderness and a painful right-sided mass. Abdominal computed tomography (CT) revealed bowel distension with an ileal loop incarcerated through the right obturator foramen. After initial resuscitative measures, the patient underwent a midline laparotomy. Surgical exploration confirmed a strangulated ileal segment that remained viable. Both obturator foramina were repaired with sutures and reinforced using adjacent tissue structures. Clinical discussion: Due to its non-specific clinical presentation, the diagnosis of OH is frequently delayed or missed. A palpable mass is rarely observed, and one of the more distinctive signs, the Howship-Romberg sign, characterized by pain radiating to the inner thigh and knee, may be mistaken for other conditions such as gonarthrosis or lumbar disc disease. Prompt use of abdominal CT imaging has been shown to improve diagnostic accuracy and can significantly reduce both the morbidity and mortality linked to this type of hernia. Conclusion: OH should be considered in at-risk individuals due to its subtle presentation. Prompt identification using CT scans and timely surgical intervention are crucial for enhancing prognosis and minimizing potential complications.