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Zhou B, Chang P, Xu H, Yang S, Xu H, Shen D. Diagnosis and surgical treatment of obturator hernia in the recent decade with long-term follow-up: A single center experience. Medicine (Baltimore) 2024; 103:e39426. [PMID: 39183429 PMCID: PMC11346891 DOI: 10.1097/md.0000000000039426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/14/2024] [Accepted: 08/02/2024] [Indexed: 08/27/2024] Open
Abstract
Obturator hernia (OH) is a rare and dangerous disease that can lead to life-threatening consequences, and pelvic computed tomography (CT) is widely used for its diagnosis. There is no consensus regarding the surgical approach and repair methods. Retrospective analysis of the clinical and follow-up data of 15 cases of incarcerated hernias patients admitted to the Department of General Surgery, affiliated to Taicang Affiliated Hospital of Soochow University, from January 2011 to December 2022. OH could be precisely diagnosed with pelvic CT scan, except for occult OH and non-strangulated OH. Thirteen patients underwent emergency surgery, with a total complication rate of 76.9% and no mortality. Ten patients underwent open surgery, and 3 patients underwent laparoscopic surgery, which had advantages in terms of total cost and postoperative hospital stay (P < .05). Emergency patients all underwent simple peritoneal closure, and hernial sac excision was simultaneously performed in 6 of them. A recurrence (7.7%) was detected at 38 months after the first operation. There was no statistically significant difference between the 2 tissue repair methods in terms of recurrent rate. Pelvic CT can be used as a gold standard for the diagnosis of incarcerated OH, but it has limited value in occult OH and non-strangulated OH. Laparoscopic surgery is recommended for patients with a short onset time and no abdominal physical signs. Tissue repair is sufficient for incarcerated OH and hernial sac excision may be unnecessary.
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Affiliation(s)
- Bin Zhou
- Department of General Surgery, Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Peng Chang
- Department of General Surgery, Taicang Affiliated Hospital of Soochow University, Suzhou, China
| | - Haibin Xu
- Department of General Surgery, Taicang Affiliated Hospital of Soochow University, Suzhou, China
| | - Siqi Yang
- School of Biomedical Sciences, Suzhou Chien-shiung Institute of Technology, Suzhou, China
| | - Hongxing Xu
- Department of General Surgery, Taicang Affiliated Hospital of Soochow University, Suzhou, China
| | - Danfeng Shen
- Department of General Surgery, Taicang Affiliated Hospital of Soochow University, Suzhou, China
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Kobayashi F, Watanabe J, Koizumi M, Yamaguchi H, Sata N. The impact of non-invasive manual and ultrasonographic reduction for incarcerated obturator hernia: a retrospective cohort study and systematic review. Hernia 2024:10.1007/s10029-024-03119-4. [PMID: 39073737 DOI: 10.1007/s10029-024-03119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Non-invasive reduction in patients with incarcerated obturator hernias is an emergency surgery alternative. There are two non-invasive reduction types: manual and ultrasonographic (ultrasound-guided and ultrasound-assisted reduction). However, the impact of ultrasound guidance on manual reduction has not been adequately evaluated. We aimed to compare non-invasive ultrasound reduction with manual reduction in patients with incarcerated obturator hernias. METHODS We searched MEDLINE, Cochrane Central Library, Embase, Ichushi Web, ClinicalTrial.gov, and ICTRP for relevant studies. The primary outcomes were success and bowel resection rates. We performed a subgroup analysis between ultrasound-guided and ultrasound-assisted reductions. This study was registered in PROSPERO (CRD 42,024,498,295). RESULTS We included six studies (112 patients, including 12 from our cohort). The success rate was 78% (69 of 88 cases) with ultrasonographic reduction and 33% (8 of 24 cases) with manual reduction. The success rate was higher with ultrasonographic than with manual reduction. Subgroup analysis revealed no significant difference between ultrasonography-assisted (76%) and ultrasonography-guided (80%) reductions (p = 0.60). Non-invasive reductions were predominantly successful within 72 h of onset, although durations extended up to 216 h in one case. Among the successful reduction cases, emergency surgery and bowel resection were necessary in two cases after 72 h from onset. Bowel resection was required in 48% (12 of 25), where the non-invasive reduction was unsuccessful within 72 h of confirmed onset. CONCLUSIONS Ultrasonographic reduction can be a primary treatment option for patients with obturator hernias within 72 h of onset by emergency physicians and surgeons on call. Future prospective studies are needed to evaluate ultrasonographic reduction's impact.
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Affiliation(s)
- Fuyumi Kobayashi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
- Department of Surgery, Tochigi Medical Center Shimotsuga, Tochigi-City, Tochigi, Japan
| | - Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke-City, Tochigi, Japan.
- Department of Surgery, Tochigi Medical Center Shimotsuga, Tochigi-City, Tochigi, Japan.
- Division of Community and Family Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
| | - Masaru Koizumi
- Department of Surgery, Tochigi Medical Center Shimotsuga, Tochigi-City, Tochigi, Japan
| | - Hironori Yamaguchi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
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Butnari V, Mansuri A, Jaiswal SP, Ahmed MW, Ewedah M, Osilli D, Di Nubila F, Buhain RL, Sarwary SH, Kaul S. Emergency transabdominal preperitoneal (TAPP) repair of a strangulated obturator hernia: A literature review and video vignette. J Clin Imaging Sci 2024; 14:5. [PMID: 38469174 PMCID: PMC10927043 DOI: 10.25259/jcis_2_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/24/2024] [Indexed: 03/13/2024] Open
Abstract
Obturator hernia (OH), a rare and potentially life-threatening condition, presents diagnostic and therapeutic challenges. This review article comprehensively delves into the clinical features, diagnosis, and management of OH, with a particular emphasis on the pivotal role of computed tomography (CT) in timely and accurate diagnosis. Delays, particularly in contrast-enhanced CT, dramatically increase mortality due to potential bowel strangulation. To illustrate the challenges and complexities surrounding OH, we present a video vignette of a 74-year-old female patient who presented with symptoms suggestive of bowel obstruction (BO) secondary to a strangulated left-sided OH. This patient case complements the theoretical framework established in the review, serving as a practical example for healthcare professionals. Her presentation included abdominal pain, absence of flatus and bowel movements, and abdominal distension. Laboratory tests demonstrated a mildly elevated white blood cell count and C-reactive protein. CT imaging confirmed the diagnosis of a strangulated OH with an ischemic small bowel. An emergency laparoscopy was undertaken, and the hernia was repaired using the transabdominal preperitoneal approach. A portion of the ischemic small bowel was resected through a 5-cm extension of the umbilical port, and an anastomosis was performed using a modified Barcelona technique. The surgery was successfully completed without immediate or long-term complications. This case highlights the crucial role of timely CT diagnosis and minimally invasive surgical management in achieving improved outcomes in acute BO secondary to OH, particularly when facilitated by pre-operative CT planning.
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Affiliation(s)
- Valentin Butnari
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Ahmer Mansuri
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Subham Prasad Jaiswal
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Mohamed Wael Ahmed
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Moataz Ewedah
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Dixon Osilli
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Francesco Di Nubila
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Robert Leonides Buhain
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Sayed Haschmat Sarwary
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Sandeep Kaul
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
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Holm MA, Baker JJ, Andresen K, Fonnes S, Rosenberg J. Epidemiology and surgical management of 184 obturator hernias: a nationwide registry-based cohort study. Hernia 2023; 27:1451-1459. [PMID: 37747656 DOI: 10.1007/s10029-023-02891-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE We aimed describe the patient characteristics, surgical details, postoperative outcomes, and prevalence and incidence of obturator hernias. Obturator hernias are rare with high mortality and no consensus on the best surgical approach. Given their rarity, substantial data is lacking, especially related to postoperative outcomes. METHODS The study was based on data from the nationwide Danish Hernia Database. All adults who underwent obturator hernia surgery in Denmark during 1998-2023 were included. The primary outcomes were demographic characteristics, surgical details, postoperative outcomes, and the prevalence and incidence of obturator hernias. RESULTS We included 184 obturator hernias in 167 patients (88% females) with a median age of 77 years. Emergency surgeries constituted 42% of repairs, and 72% were laparoscopic. Mesh was used in 77% of the repairs, with sutures exclusively used in emergency repairs. Concurrent groin hernias were found in 57% of cases. Emergency surgeries had a 30-day mortality of 14%, readmission rate of 21%, and median length of stay of 6 days. Elective surgeries had a 30-day mortality of 0%, readmission rate of 10%, and median length of stay of 0 days. The prevalence of obturator hernias in hernia surgery was 0.084% (95% CI: 0.071%-0.098%), with an incidence of one per 400,000 inhabitants annually. CONCLUSIONS This was the largest cohort study to date on obturator hernias. They were rare, affected primarily elderly women. The method of repair depends on whether the presentation is acute, and emergency repair is associated with higher mortality.
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Affiliation(s)
- M A Holm
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, DK, Denmark.
- Emergency Department, Nykøbing Falster Hospital, Ejergodvej 63, 4800, Nykøbing Falster, Denmark.
| | - J J Baker
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, DK, Denmark
| | - K Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, DK, Denmark
| | - S Fonnes
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, DK, Denmark
| | - J Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, DK, Denmark
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Nguyen MT, Nguyen VQ. Concurrent strangulated obturator hernia and femoral hernia repair via TAPP approach: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231185956. [PMID: 37539355 PMCID: PMC10395156 DOI: 10.1177/2050313x231185956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/16/2023] [Indexed: 08/05/2023] Open
Abstract
An obturator hernia is a rare pelvic hernia with high mortality. Early diagnosis and treatment are essential to reduce postoperative complications. The treatment of choice for obturator hernias is surgery. In an emergency, laparotomy to resolve herniated viscera and complications is often the choice. However, some researchers have shown the feasibility of laparoscopy. The laparoscopic approach has several benefits over the open approach, including reduced postoperative pain, early mobilization, shorter length of stay, and lower postoperative morbidity rates. We report the case of an 81-year-old woman with a right-side obstructed obturator hernia. The patient was hospitalized with an acute onset of inner thigh pain and bowel obstruction. The obturator hernia was diagnosed preoperatively by an abdominopelvic CT scan with the image of protrusion of an ileal loop in the right obturator foramen. The patient was treated by an emergency laparoscopy. The right obturator hernia and a concurrent right femoral hernia were confirmed during the operation. The hernia defect was repaired with a mesh large enough to cover all hernia foramen. The patient recovered without any complications. Emergency laparoscopic repair for obstructed obturator hernia was safe and effective.
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Affiliation(s)
- Minh Thao Nguyen
- Digestive Surgery Department, Hue University of Medicine and Pharmacy Hospital, Hue University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue, Vietnam
| | - Van Quy Nguyen
- General Surgery Department, Franco-Vietnamese Hospital, Ho Chi Minh City, Vietnam
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Ghimire S, Dhakal SKS, Rai P, Rai N. Early CT Ameliorates the Diagnostic Dilemma of "Little Old Lady's Hernia": A Case Report. JNMA J Nepal Med Assoc 2022; 60:735-738. [PMID: 36705222 PMCID: PMC9446500 DOI: 10.31729/jnma.7499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/27/2022] [Indexed: 01/31/2023] Open
Abstract
Encountering an obturator hernia itself is a rare entity for practicing surgeons globally. Synonymously known as the "old lady's hernia" is usually seen in fragile geriatric multiparous female patients. We share our experience of this rare entity where the patient presented with features of small bowel obstruction. Her diagnosis was delayed in the previously attended other centre as the possibility of an obturator hernia was overlooked. A timely clinical examination of the patient complemented by a computed tomography scan of the abdomen and pelvis helped us to obtain a diagnosis and proceed with immediate surgery. Intraoperatively the rarity was present bilaterally although the obstruction was on one side only. Prompt diagnosis and treatment benefits patients in this potentially lethal condition. Keywords case report; computed tomography; obturator hernia; X-ray.
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Affiliation(s)
- Subodh Ghimire
- Department of General Surgery and Digestive Diseases, Nepal Mediciti Hospital, Bhaisepati, Lalitpur, Nepal,Correspondence: Dr Subodh Ghimire, Department of General Surgery and Digestive Diseases, Nepal Mediciti Hospital, Lalitpur, Nepal. , Phone: +977-9841547225
| | - Sunil Kumar Sharma Dhakal
- Department of General Surgery and Digestive Diseases, Nepal Mediciti Hospital, Bhaisepati, Lalitpur, Nepal
| | - Pranil Rai
- Department of General Surgery and Digestive Diseases, Nepal Mediciti Hospital, Bhaisepati, Lalitpur, Nepal
| | - Nirvan Rai
- Department of General Surgery and Digestive Diseases, Nepal Mediciti Hospital, Bhaisepati, Lalitpur, Nepal
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Yamaguchi K, Kitamura M, Hashiguchi J, Harada T, Funakoshi S, Eguchi S, Mukae H, Nishino T. Two cases of obturator hernia in patients undergoing hemodialysis: case report and literature review. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Obturator hernia (OH) is an extremely rare abdominal wall hernia with risk factors including aging, female sex, emaciation, and increased abdominal pressure. Its symptoms are nonspecific, and diagnosis is often delayed; however, this delay can lead to a fatal course. Therefore, early diagnosis and surgical intervention are necessary to reduce the mortality rate associated with OH. Considering the risk factors for OH, patients currently undergoing hemodialysis (HD) may be particularly vulnerable to OH. Here, we report two cases of OH in patients undergoing HD along with a review of the relevant literature.
Case presentation
Case 1 included a 76-year-old female undergoing HD due to autosomal dominant polycystic kidney disease. She was hospitalized for upper abdominal pain, vomiting, and diarrhea. On the day of hospitalization, she was diagnosed with OH using computed tomography and underwent emergency surgery. Case 2 included a 90-year-old emaciated female who was admitted to our hospital for projectile vomiting while undergoing HD. She was diagnosed with OH and shock, but surgery was not performed due to shock. Nonetheless, her blood pressure gradually increased, and she completely recovered. Spontaneous reduction in OH was confirmed on the third day of hospitalization. Both patients recovered well.
Conclusions
The symptoms of OH are non-specific, and certain symptoms such as vomiting and anorexia are often overlooked because they are common in patients undergoing HD. It is important to include OH in the differential diagnosis of digestive organ symptoms in patients undergoing HD, especially in those with risk factors for OH, such as elderly female patients on HD due to autosomal dominant polycystic kidney disease.
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Mercado M, Diab J, Loi K. A delayed diagnosis of obturator hernia hoodwinked by previous laparoscopic inguinal hernia repair. J Surg Case Rep 2021; 2021:rjab407. [PMID: 34567521 PMCID: PMC8460275 DOI: 10.1093/jscr/rjab407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/10/2021] [Accepted: 08/22/2021] [Indexed: 01/10/2023] Open
Abstract
Obturator hernia is a rare and diagnostically challenging type of pelvic hernia with associated high morbidity and mortality. It is frequently seen in frail, elderly female multiparous patients with non-specific symptoms and signs that may be clouded by multiple gastrointestinal or musculoskeletal comorbidities. This report discusses the case of an 84-year-old woman with refractory groin pain and previous laparoscopic inguinal hernia repair that was misdiagnosed leading to a delayed diagnosis and mortality. Previous laparoscopic repair was a misleading factor that hoodwinked clinicians and surgeons until computed tomography (CT) imaging proved otherwise. In emaciated, elderly female patients presenting with non-specific abdominal or hip pain, early CT imaging can assist in diagnosis when signs or symptoms are unclear. Clinical vigilance and serial examination are important in elderly patients who are often under the care of geriatricians allowing early discovery and treatment of this hernia.
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Affiliation(s)
- Melanie Mercado
- Department of General Surgery, St George Hospital, Kogarah, NSW, Australia
| | - Jason Diab
- Department of General Surgery, St George Hospital, Kogarah, NSW, Australia
| | - Ken Loi
- Department of General Surgery, St George Hospital, Kogarah, NSW, Australia
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