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Obturator hernia is a rare but important cause of intestinal obstruction. The mortality rate is high if the diagnosis is not made early and surgical intervention is delayed. We report an 88-year-old female patient who presented with aspiration pneumonia and respiratory failure. She did not have nausea/vomiting and physical examination was unremarkable. She was fed through a nasogastric tube, but no gastric emptying was noted. An abdominal/pelvic computed tomograpy (CT) scan performed 5 days after the presentation revealed a left incarcerated obturator hernia. Emergency laparotomy was performed and the patient eventually recovered. This case reminds us that aspiration pneumonia may be the presenting feature of obturator hernia and a clue to its early diagnosis.