it accounts for < 1% of all hernias . typically , they manifest in multiparous , thin females within their seventh to ninth decades of life . patients frequently present with symptoms of intestinal obstruction and , occasionally , pain along the distribution of the obturator nerve on the ipsilateral side ( howship  romberg sign ) . however , the diagnosis can be difficult to make and delay in diagnosis and surgical intervention contributes directly to high morbidity and mortality rates . the authors report the successful laparoscopic management of an acute presentation of an obstructed obturator hernia . an 85-year - old female with a background of trans - abdominal hysterectomy , hypertension and a previous thyroid lobectomy , presented acutely with a 1-day history of upper abdominal pain radiating down her left leg associated with numerous episodes of emesis . her bowels had opened three times in the previous 24 h. she was anorexic for the previous 24 h. she reported a similar episode requiring hospitalization 3 weeks before , which was treated non - operatively in another institution . on examination , she was treated presumptively as a small bowel obstruction and non - operative measures were employed and the patient proceeded to have a computed tomography ( ct ) scan of the abdomen and pelvis , which indicated proximal small bowel obstruction secondary to a left obturator hernia ( fig .  1 ) . she proceeded to emergent laparoscopy and subsequent mesh repair of left obturator hernia , containing an obstructed loop of small bowel . proximal small bowel obstruction secondary to a left obturator hernia within white outline . under general anaesthetic , the optical technique for access was utilized at the umbilicus with a 5 mm port . two further working ports , a 5 and 10 mm , were placed in the right lower quadrant and right hypochondrium , under direct vision . findings included visualization of small bowel dilatation down to small bowel in a left obturator hernia with an incidental left femoral hernia containing omentum ( fig . the incarcerated small bowel was reduced using a pair of non - traumatic forceps and deemed viable . figure 2:intraoperative image showing left sided obturator hernia within white outline and incidental femoral hernia at 11o clock position . intraoperative image showing left sided obturator hernia within white outline and incidental femoral hernia at 11o clock position . sommerville , nj , usa ) tacked with absorbatack ( covidien , mansfield , inc . , this then allowed the mesh to be spread laterally and fixed to the transversalis fascia . the femoral hernia was repaired with 2  2/0 vicryl ( ethicon , inc . , the patient did suffer a post - operative pneumonia but was treated appropriately , made a good recovery and was discharged home well . conditions associated with long - standing increased intra - abdominal pressure , weight loss that leads to a decreased peritoneal fat and multiparity are implicated on the basis of laxity of the parietal peritoneum . all are believed to increase the risk for development of an obturator hernia and women are affected nine times more frequently than men . the obturator membrane covers most of the foramen , except at the anterior superior aspect . the anatomic formation of obturator hernia has been previously described in detail in the literature , but the basic premise of the aetiology and pathogenesis is based on the loss of preperitoneal fat or lymphatic tissue that occupies the obturator canal . classic features of an obturator hernia : ( i ) a palpable mass in the groin with the patient supine , and the thigh flexed , adducted and rotated laterally ; ( ii ) intestinal obstruction ; ( iii ) previous attacks of bowel obstruction resolving spontaneously ; ( iv ) the howship romberg sign is medial thigh and hip pain exacerbated by adduction and medial rotation of the thigh and relieved by thigh flexion . the usefulness of ct in diagnosis was first reported by cubillo in 1983 and it has been assisting in the earlier diagnosis of obturator hernia but despite this post - operative mortality has not improved remarkably . however , several studies have shown the feasibility of laparoscopic techniques for the management of incarcerated obturator hernia . the transabdominal preperitoneal repair for obturator hernias is the preferred technique as it allows assessment of the visceral contents . the current trend is to repair the defect using prosthetic material ; however , there is no robust evidence in the literature to compare and contrast the superiority of mesh repair over other repairs in obturator hernia . in conclusion , we present this rare case to raise awareness of a rare presentation but with significant morbidity and mortality if a high index of suspicion is not maintained . this case illustrates the usefulness of ct in diagnosing obturator hernia and it also confirms that laparoscopic mesh repair of an incarcerated obturator hernia is safe and technically feasible .
obturator hernia is a rare pelvic hernia that occurs primarily in multiparous , elderly ( > 70 years of age ) , thin females . 
 this case highlights the successful laparoscopic mesh repair of an incarcerated obturator hernia in an octogenarian.the authors report a case of an incarcerated obturator hernia in an elderly female with subsequent high - grade small bowel and its successful laparoscopic operative management . 
 a review of the relevant literature was also performed following a search on the online literature databases such as pubmed and embase . 
 laparoscopic mesh repair of the incarcerated obturator hernia and an ipsilateral femoral hernia found incidentally was successfully performed . 
 a review of the literature showed a significant burden of morbidity and mortality associated with obturator hernias . 
 laparoscopic mesh repair has been previously shown to be a safe therapeutic modality . 
 small bowel obstruction and leg pain in a thin elderly lady should arouse suspicion for an incarcerated obturator hernia . 
 laparoscopic management of an incarcerated obturator hernia is a feasible and safe therapeutic option .