Image of the Month—Diagnosis | Gastrointestinal Surgery | JAMA Surgery | JAMA Network
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Special Feature
June 16, 2008

Image of the Month—Diagnosis

Arch Surg. 2008;143(6):608. doi:10.1001/archsurg.143.6.608

Figure 2(axial computed tomography) reveals a right-sided obturator hernia containing the distal ileum. The herniated bowel loop shows prominent wall enhancement consistent with early vascular compromise. A diagnosis of strangulating obturator hernia causing small-bowel obstruction was made, and the patient underwent laparotomy.

The small bowel within the hernia was reduced with gentle traction. An ischemic-looking 2-cm knuckle of bowel was found and resected with 3-cm margins. After lavage of the peritoneal cavity, the mesenteric defect was closed with Vicryl sutures. A composite mesh (Parietex; Covidien, Mansfield, Massachusetts) was then sutured to the pubic symphysis in the midline and to the Cooper ligament laterally. The lateral free edge of the mesh was sutured inferiorly to the round ligament. The lower edge was laid down into the pelvic floor. Our patient had an uneventful postoperative recovery and was discharged home a week later.

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