Diagnostic Pitfalls in Obturator Hernia: A Case Report and Literature Review.

Obturator hernia is a rare clinical entity that predominantly affects elderly, thin women due to anatomical factors such as a wider pelvis and the loss of preperitoneal fat. Despite its classic description, the preoperative diagnosis remains a major challenge due to its deep location and non-specific presentation as a mechanical small bowel obstruction. This report describes the case of a 66-year-old female whose history of prior abdominal surgeries created a diagnostic bias toward adhesive obstruction, resulting in an initial period of conservative management. The most significant clinical signs were absent, leading to a delay in obtaining advanced imaging. Computed tomography eventually identified a right-sided obturator hernia complicated by intestinal perforation. During emergency laparotomy, fecal peritonitis and a friable ileal loop with multiple perforations were identified, necessitating a significant bowel resection. Due to the gross contamination of the surgical field, the defect was repaired using a primary suture technique to minimize the risk of infection associated with prosthetic materials. The patient's fatal outcome underscores that the prognosis of this condition depends primarily on the timing of the diagnosis and prompt surgical intervention. High clinical suspicion in geriatric patients with intestinal obstruction, even in those with a history of prior surgery, is fundamental to reducing the mortality associated with this condition. The choice of primary repair remains a safe and necessary strategy in the presence of fecal contamination to avoid complex postoperative complications.