A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h. The pain localized over the periumbilical area with radiation along the medial side of the thigh. Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal.Incarcerated obturator hia was diagnosed and emergency laparotomy was arranged immediately.Unfortunately, her family refused surgery because of her worsening condition. On the third evening after admission, the patient developed peritonitis and sepsis.Perforation of small bowel due to the incarceration was noted during laparotomy. Bowel resection and an endileostomy were performed. She recovered well despite of the complication of multiple organ dysfunction syndrome. Literature is reviewed, and the pathogenesis,clinical manifestation, imaging features and treatment are discussed.