title: Obturator hernia: A diagnostic challenge.
abstract: METHODS
  Female, 90 FINAL DIAGNOSIS: Obturator hernia Symptoms: Epigastric pain • vomiting
  
  
  METHODS
  - Clinical Procedure: - Specialty: Gastroenterology and Hepatology.
  
  
  OBJECTIVE
  Challenging differential diagnosis.
  
  
  BACKGROUND
  Obturator hernia (OH) can be difficult to diagnose because it shows only nonspecific signs and symptoms. Although pain in a lower limb caused by compression of the obturator nerve by the hernia in the obturator canal (Howship-Romberg sign) is a characteristic sign, its presence is rather rare.
  
  
  METHODS
  We herein describe the case of a 90-year-old woman with an OH that was difficult to diagnose because of her slight abdominal signs and symptoms on admission and subtle abdominal computed tomography (CT) findings. Although the CT images revealed the presence of an OH, this finding was overlooked because it contained only a part of the small intestine wall, which is called the Richter type. Fortunately, her condition improved dramatically with only conservative treatment.
  
  
  CONCLUSIONS
  Although early diagnosis is essential to reduce morbidity and mortality, OH can be a diagnostic challenge even with abdominal CT.
authors.affiliation: Department of General Medicine, Saga University Hospital, Saga City, Japan ; The Community Center of General Medicine, Saga University Hospital, Saga City, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Tokushima
authors.affiliation: Department of General Medicine, Saga University Hospital, Saga City, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Aihara
authors.affiliation: Department of General Medicine, Saga University Hospital, Saga City, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Tago
authors.affiliation: Department of General Medicine, Saga University Hospital, Saga City, Japan.
authors.forename: Motosuke
authors.initials: M
authors.lastname: Tomonaga
authors.affiliation: The Community Center of General Medicine, Saga University Hospital, Saga City, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Sakanishi
authors.affiliation: Department of General Medicine, Saga University Hospital, Saga City, Japan.
authors.forename: Tsuneaki
authors.initials: T
authors.lastname: Yoshioka
authors.affiliation: Department of General Medicine, Saga University Hospital, Saga City, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Hyakutake
authors.affiliation: Department of General Medicine, Saga University Hospital, Saga City, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Kyoraku
authors.affiliation: The Community Center of General Medicine, Saga University Hospital, Saga City, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sugioka
authors.affiliation: Department of General Medicine, Saga University Hospital, Saga City, Japan.
authors.forename: Shu-Ichi
authors.initials: S
authors.lastname: Yamashita
keywords: Geriatrics; Hernia – diagnosis; Ileus – diagnosis