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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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Aryal M, Keshari S, Pandey A, Pandey A, Paudel I. A rare case of left-sided obturator hernia diagnosed by computed tomography. Clin Case Rep 2023; 11:e7297. [PMID: 37180335 PMCID: PMC10167614 DOI: 10.1002/ccr3.7297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/03/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023] Open
Abstract
Obturator hernia is a rare condition that is difficult to detect clinically. We highlight the importance of a CT scan in establishing an early diagnosis of an obturator hernia, effective surgical intervention planning, thereby enhancing the result.
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Affiliation(s)
- Manisha Aryal
- Kathmandu University School of Medical SciencesDhulikhel HospitalDhulikhelNepal
| | - Suraj Keshari
- Kathmandu University School of Medical SciencesDhulikhel HospitalDhulikhelNepal
| | - Archana Pandey
- Kathmandu University School of Medical SciencesDhulikhel HospitalDhulikhelNepal
| | - Abhishek Pandey
- Kathmandu University School of Medical SciencesDhulikhel HospitalDhulikhelNepal
| | - Ishwor Paudel
- National Academy for Medical SciencesBir HospitalKathmanduNepal
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Bohara S, Karki S, Gautam A, Regmi BU, Rimal S, Khadka L, Pokharel A, Gurung B, Rawal SB. Obturator hernia (the little old lady's hernia) diagnosed via computed tomography: a case report. Ann Med Surg (Lond) 2023; 85:1282-1285. [PMID: 37113834 PMCID: PMC10129172 DOI: 10.1097/ms9.0000000000000578] [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: 12/30/2022] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
Obturator hernia is an infrequent clinical entity of abdominal wall hernia, accounting for an incidence rate ranging from 0.073 to 2.2% of all hernias and being responsible for 0.2-1.6% of all cases of mechanical intestinal obstruction. The computed tomography (CT) scan, as an imaging modality, is critical in improving the diagnostic rate of obturator hernia. Case presentation The authors herein report an 87-year-old thin male patient with a known history of chronic obstructive pulmonary disease who presenting with complaints of abdominal pain for 3 days and constipation for 2 days, as well as one episode of vomiting without any features of peritoneal irritation, which was diagnosed early as a right-sided obturator hernia via CT and managed with exploratory laparotomy with hernia reduction and polypropylene mesh repair. Discussion Obturator hernia is a rare surgical phenomenon with a varied clinical spectrum, ranging from asymptomatic to presenting as intestinal obstruction. The CT scan plays a critical role in the detection of obturator hernias, which ameliorates the possible significant postoperative morbidity and mortality. Conclusion This report demonstrates that a high index of suspicion combined with CT imaging aids in early diagnosis and management, thus overcoming the reluctant morbidity.
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Affiliation(s)
- Sujan Bohara
- Departments of General and Gastrointestinal Surgery
- Corresponding author. Address: Department of General and Gastrointestinal Surgery, Nepal Mediciti Hospital, Lalitpur 44700, Nepal. Tel.: 9779860103009. E-mail: (S. Bohara)
| | | | - Anu Gautam
- Nepalese Army Institute of Health Sciences, Kathmandu
| | | | | | | | - Anuj Pokharel
- Nepalese Army Institute of Health Sciences, Kathmandu
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Tobe T, Yuen K, Yasufuku T, Uematsu R, Miyazaki A, Yamashita M. Laparoscopic port site Richter's hernia after robot‐assisted radical prostatectomy. IJU Case Rep 2022; 5:501-504. [PMID: 36341190 PMCID: PMC9626317 DOI: 10.1002/iju5.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Postoperative small bowel obstruction is a rare complication. One of its less frequent causes is port site hernia. We report a case of Richter's port site hernia in a patient who underwent robot‐assisted radical prostatectomy. Case presentation A 73‐year‐old man who underwent robot‐assisted radical prostatectomy noted acute abdominal pain and nausea on the 11th postoperative day. Computed tomography scans revealed dilated small bowel loops. Adhesive ileus was initially suspected, which was relieved with conservative management, including ileus tube insertion. However, his symptoms worsened. Thus, a laparotomy was performed. The camera port wound was reopened, and the repaired fascia and small intestine were found incarcerated into the peritoneal defects. These findings were consistent with Richter's hernia. Conclusion Port site hernia was not detected on computed tomography scans. Patients presenting with small bowel obstruction following laparoscopic surgery should be evaluated for port site hernia, and surgical management should be considered.
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Affiliation(s)
| | - Keiji Yuen
- Department of Urology Shiko Hospital Kobe Japan
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Khalifa MB, Maatouk M, Ghannouchi M, Hammouda S, Nacef K, Boudokhane M. Obturator hernia: A case report of intestinal obstruction with challenging diagnosis and non-standardized treatment. Int J Surg Case Rep 2022; 94:107016. [PMID: 35421725 PMCID: PMC9019259 DOI: 10.1016/j.ijscr.2022.107016] [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: 03/07/2022] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance Obturator Hernia (OH) is a rare clinical entity that constitue less than 1% of all abdominal hernias. It happens in elderly thin women malnourished. The diagnosis is usually delayed because symptoms are non-specific, and patients commonly have features of intestinal obstruction. There are no international guidelines for treatment and the best surgical approach still unknown. Case presentation We report a case of strangulated OH in a 75 year woman who consulted in our service for an acute intestinal obstruction. Intra-operatively findings showed loop of ileum entering through a defect in the right obturator canal. The obturator defect was closed by approximation flap of peritoneum and covered by right ovair and fallopian tube. Clinical discussion This case is reported because of its an uncommon type of abdominal wall hernia with high probability of bowel strangulation and highest morbidity and mortality rates. There are no international guidelines for treatment and the best surgical approach still unknown. Conclusion The diagnosis of OH should be suspected every time there is an intestinal obstruction of unknown origin in emaciated elderly women. Open or laparoscopic sutured repair surgery and placement of mesh remain the most common method of repair. Obturator Hernia is an uncommon type of abdominal wall hernia. It has the highest morbidity and mortality rates of all abdominal wall hernias. Emergency surgery is crucial for the treatment of strangulated obturator hernia. The ideal treatment and the best surgical approach still unknown.
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Affiliation(s)
- Mohamed Ben Khalifa
- General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia.
| | - Mohamed Maatouk
- A21 Surgery Department, Research Laboratory LR12ES01, Charles Nicolle Hospital, Faculty of Medicine of Tunis/Tunis El Manar University, Rue 9 avril - 1007 Bab Saadoun, Tunis, Tunisia
| | - Mossaab Ghannouchi
- General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia
| | - Seif Hammouda
- General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia
| | - Karim Nacef
- General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia
| | - Moez Boudokhane
- General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia
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Kim JY, Chang MC. Obturator hernia - a rare etiology of lateral thigh pain: A case report. World J Clin Cases 2021; 9:10728-10732. [PMID: 35005008 PMCID: PMC8686155 DOI: 10.12998/wjcc.v9.i34.10728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/02/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lateral thigh pain is a common complaint in patients visiting a pain clinic. Herein, we describe the case of a patient with lateral thigh pain caused by an obturator hernia.
CASE SUMMARY An 83-year-old woman visited the emergency room with suddenly aggravated right lateral thigh pain. Magnetic resonance imaging of the thigh revealed no abnormal findings in the lateral thigh area. However, an obturator hernia between the pectineus and obturator externus muscles was observed by chance. Retroperitoneal computed tomography revealed a herniated small bowel with an incarceration point at the right obturator canal and a dilated loop of the small bowel upstream. Ultrasonography of the right inguinal region revealed a distended bowel loop in the right pectineus muscle.
CONCLUSION Our report provides clinicians with information that an obturator hernia can cause lateral thigh pain.
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Affiliation(s)
- Jun Young Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu 705-717, South Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu 705-717, South Korea
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An unusual case of early-stage obturator hernia causing bowel obstruction and strangulation. Radiol Case Rep 2021; 17:176-180. [PMID: 34815822 PMCID: PMC8593257 DOI: 10.1016/j.radcr.2021.10.030] [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: 10/04/2021] [Revised: 10/13/2021] [Accepted: 10/16/2021] [Indexed: 11/23/2022] Open
Abstract
Obturator hernia is rare, contributing to less than 2% of the total incidence of small bowel obstructions. The diagnosis of obturator hernia is still a big challenge today. Abdominopelvic Computed Tomography scans have better diagnostic value preoperatively, showing the bowel loop between the pectineus and obturator externus muscle. We report an unusual case of a 77-year-old woman who presented to the emergency ward with an acute abdominal pain. Plain abdominal radiography showed small bowel obstruction. However, a computed tomography scan only showed signs of closed-loop obstruction and strangulation with bulging of the peritoneum through the obturator foramen. Exploration by laparotomy allowed complete evaluation of the obturator canal and confirmed the diagnosis of obturator hernia as a cause of bowel obstruction and strangulation.
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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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Chuah JS, Tan Chor Lip H. Strangulated obturator hernia with ischaemic and perforated small bowel. ANZ J Surg 2021; 92:910-911. [PMID: 34541761 DOI: 10.1111/ans.17196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jun Sen Chuah
- Department of General Surgery, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia.,Department of General Surgery, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Henry Tan Chor Lip
- Department of General Surgery, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Malaysia
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Major CK, Aziz M, Collins J. Obturator hernia: a case report. J Med Case Rep 2021; 15:319. [PMID: 34140042 PMCID: PMC8212532 DOI: 10.1186/s13256-021-02793-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 03/16/2021] [Indexed: 12/19/2022] Open
Abstract
Background Obturator hernia is rare and accounts for less than 1% of all abdominal wall hernias. It represents a diagnostic challenge due to its nonspecific signs and symptoms. Case presentation We present a case of an 89-year-old caucasian female with a 12-hour history of right medial thigh pain. Computed tomography scan revealed a right obturator hernia with small bowel obstruction. The hernia was successfully repaired laparoscopically without any need for small bowel resection. She was discharged on postoperative day 2 with an uneventful recovery and zero complications. Conclusion This case report highlights the importance of rapid diagnosis and repair of obturator hernia even in the setting of an improving clinical picture. It also demonstrates the safety of laparoscopic repair in this setting.
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Affiliation(s)
- C Kendall Major
- Department of Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Norfolk, VA, USA
| | - Madiha Aziz
- Department of Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Norfolk, VA, USA
| | - Jay Collins
- Department of Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Norfolk, VA, USA.
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Li Z, Gu C, Wei M, Yuan X, Wang Z. Diagnosis and treatment of obturator hernia: retrospective analysis of 86 clinical cases at a single institution. BMC Surg 2021; 21:124. [PMID: 33750366 PMCID: PMC7941974 DOI: 10.1186/s12893-021-01125-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/26/2021] [Indexed: 02/08/2023] Open
Abstract
Background To explore the clinical characteristics, diagnosis and treatment of obturator hernia. Methods Eighty-six patients who were diagnosed as obturator hernia by abdominal CT in the Department of Gastrointestinal Surgery of our hospital between 2009 and 2019 were enrolled in this study. Patient characteristics, surgical method, postoperative complications and mortalities were retrospectively reviewed. Results Thirty days mortality rate of 5.5% and 46.1% were observed in surgery group and non-surgery group, respectively. Surgery was performed as an emergency procedure in 59 cases and elective procedure in 14 cases depending on different hernia contents, intestinal necrosis and signs of peritonitis. In the emergency surgery group, segmental intestinal resection with anastomosis was performed in 24 patients (24/59, 40.7%). There were 4 deaths (4/59, 6.8%) in this group, all of which occurred in patients undergoing SI resections. In contrast, no bowel resection, postoperative complications, or death occurred in the elective surgery group. 3-year recurrence rates of 5.1% (3/59) and 7.1% (1/14) were observed in the emergency surgery and the elective surgery group, respectively. Conclusions CT examination plays an important role in improving the diagnostic rate of obturator hernia. Timely surgical treatment is the key to improve the efficacy of obturator hernia and prevent the deterioration of the condition. In addition, intestinal resection and postoperative complications may be the important factors leading to postoperative death.
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Affiliation(s)
- Zhengzheng Li
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Xing Yuan
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China.
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