Obturator hernia

Ileum perforation due to delayed operation in obturator hernia: A case report and review of literatures

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 hernia 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 end-ileostomy 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.

Preoperative diagnosis and successful laparoscopic treatment of incarcerated obturator hernia

Obturator hernia is rare and frequently delayed in surgical treatment and, thus, is associated with high morbidity and mortality. It is often found in thin, elderly, multiparous women. We reported a case of early diagnosis due to clinical alert and in-time computed tomography (CT). The patient received laparoscopic surgery and had good postoperative recovery. The regular use of CT for diagnosing nonspecific abdominal complaints associated with pain over the inner thigh, especially in thin, elderly, multiparous women, will result in increased preoperative detection of the obturator hernia.

Laparoscopic repair of obturator bladder hernia: a case report and review of the literature

Hernias through the obturator foramen are rare and are difficult to diagnose. They usually appear in elderly women, have an atypical presentation, and are associated with high mortality. The most frequently compromised organ is the small bowel. Hernias that involve the small bowel are often associated with intestinal obstruction and secondary necrosis. Several techniques and approaches have been described for management. We present a case of bladder hernia through the obturator foramen that we repaired laparoscopically by placing a mesh plug, a management option we find safe, fast, and effective.

Obturator hernia as a cause of chronic pain after inguinal hernioplasty: elective management using tomography and ambulatory total extraperitoneal laparoscopy

Obturator hernia is a rare variety of pelvic hernia. Preoperative diagnosis is still uncommon and influences treatment and prognosis. Clinical suspicion and tomography are fundamental for establishing a preoperative diagnosis. Subsequently, elective treatment via the total extraperitoneal laparoscopic approach seems to offer the best results for both the patient and the hospital. This management might reduce the high rates of associated morbidity and mortality. We present the case of a patient with chronic pelvic pain after hernia surgery in whom tomography confirmed the existence of a bilateral obturator hernia. Details are given of diagnostic and therapeutic management using ambulatory total extraperitoneal laparoscopy. We recommend ruling out obturator hernia as a possible cause of chronic pain after hernia repair.

A rare cause of intestinal obstruction: incarcerated femoral hernia, strangulated obturator hernia

Obturator hernia may occur bilaterally in association with another hernia, which is usually of the femoral type. We present a 77-year-old-woman who had abdominal pain with nausea and vomiting together with swelling of the right groin for 3 days. Incarcerated right femoral hernia and consequent mechanical small-bowel obstruction was diagnosed, and urgent operation was undertaken. As the incarcerated femoral hernia reduced spontaneously during the induction of anesthesia, a lower median incision was performed. During exploration, the real cause of mechanical intestinal obstruction was found to be a small intestinal loop strangulated in the left obturator hernia. Right femoral and left obturator hernia were repaired with preperitoneal polypropylene mesh. If there is enough time and general condition of the older patient is suitable, further diagnostic techniques for concomitant obturator hernias may be useful in patients who present with signs of incarcerated inguinal hernia and intestinal obstruction.

Laparoscopic transabdominal preperitoneal hernioplasty of bilateral obturator hernia

Obturator hernia is relatively rare and tends to occur in elderly, emaciated women with chronic diseases. Clinical presentations are frequently delayed and so preoperative diagnosis is difficult. Treatment is always surgical. We present a case of a 75-year-old woman with bilateral obturator hernia diagnosed by the physical examination and abdominopelvic computed tomography (CT) scan; she had no signs of bowel strangulation. We used a laparoscopic approach for correction. A transabdominal preperitoneal hernioplasty was done using a prosthetic patch of polypropylene mesh. The patient recovered very well after surgery. We suggest that a laparoscopic approach may be used as treatment, when a nonstrangulated obturator hernia is diagnosed preoperatively.

Totally extraperitoneal repair of obturator hernia

BACKGROUND

One distinct advantage of the 1aparoscopic inguinal hernia repair is the opportunity for clear visualization of the direct, indirect, femoral, and obturator spaces. The surgeon should routinely inspect all of them. Obturator hernia accounts for as few as 0.073% of all hernias, but the mortality rate when it is acutely incarcerated can be as high as 70%. There is only one previous report of a totally extraperitoneal repair for obturator hernia. Five such procedures are described.

METHODS

A retrospective review was undertaken to evaluate one surgeon's experience with the totally extraperitoneal repair of obturator hernia over a 4-year period. Four of five cases were completed, and the remaining case was converted to an open procedure.

RESULTS

Three hernias were on the right side, and two on the left. One patient presented with an acutely incarcerated obturator hernia and underwent a small bowel resection for strangulated bowel within the obturator space. The other four hernias were found during totally extraperitoneal repair, and the patients were discharged home several hours later. There was one complication, a midline wound infection in the patient with strangulated bowel. It was treated with dressing changes. There were no other complications, and during a follow-up period of 3 to 48 months, there was no recurrence.

CONCLUSIONS

The laparoscopic totally extraperitoneal approach allows inspection and repair of direct, indirect, femoral, and obturator hernias. This study found this procedure to be feasible, safe, and highly effective for the diagnosis and repair of obturator hernias.

Gangrenous appendicitis in a strangulated obturator hernia

Only two cases of appendicitis in strangulated obturator hernia have been previously reported. In the present case, an 83-year-old woman had fatal anaerobic myonecrosis of the thigh that resulted from gangrenous appendicitis in the right obturator foramen. Early diagnosis, prompt surgical intervention, and perioperative resuscitation are critical for survival in a case of appendicitis in a strangulated obturator hernia with thigh sepsis, especially when it occurs in an elderly, emaciated female patient.

[Strangulated obturator hernia: a report of 17 cases]

PURPOSE OF THE STUDY

To assess clinical, therapeutic and diagnostic findings of strangulated obturator hernias.

PATIENTS AND METHOD

Retrospective study of 17 patients (16 women, 1 man; average age: 81.7 years), all treated in the same service, for strangulated obturator hernia. The studied criteria were: clinical characteristics (general status, obstruction, sign of Romberg-Howship), morphologic exams, mean delay for surgical treatment, and occurrence of postoperative complications.

RESULTS

The clinical examination revealed small bowel obstruction in 94% of the patients (n = 16) and incomplete obstruction in 1 patient; 23.5% of the patients presented a sign of Romberg-Howship. A major slimming was observed in 82% of the cases. A computed tomography, performed in 3 patients, showed the presence of air in the under-pubic channel. Preoperative diagnosis of obturator hernia was suspected in 23.5% of the cases. Surgical treatment was performed after a mean delay of 5.3 d. The mortality and morbidity rates were respectively 35 and 18%.

CONCLUSION

Due to the low specificity of clinical examination, preoperative diagnosis of obturator hernia remains difficult. Computed tomography can be of great help for the diagnosis. Any therapeutic delay increasing mortality rate, surgery is mandatory in case of small bowel obstruction in order to make the diagnosis and the treatment of such rare pathology.