Clinical Presentation

A 91-year-old woman presents to the emergency department with intense abdominal pain.

(A) Contrast-enhanced computed tomography (CT) shows a markedly dilated loop of small bowel in the pelvis (arrows). (B) More caudal slice shows a segment of small bowel (arrow) between the external obturator and pectineus muscles.

Differential Diagnosis

• Obturator foramen hernia: This is the only diagnosis based on the finding of small-bowel obstruction, dilated small bowel, as well as a fluid-filled structure in the obturator foramen.

Essential Facts

• Pelvic external hernias are congenital, traumatic, or post-surgical herniations of pelvic contents through the pelvic wall or groin. They include inguinal, femoral, obturator, sciatic, and perineal hernias.