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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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2
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Bialecki J, Antkowiak R, Adamiecki M, EngD AK, Antkowiak L, Szmit M, Domoslawski P. Incidentally found obturator hernias during totally extraperitoneal (TEP) inguinal hernia repair: a single-center experience. Hernia 2024; 28:1145-1149. [PMID: 38488932 DOI: 10.1007/s10029-024-02991-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/11/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE This study aimed to determine the occurrence of incidental obturator hernia and clinical risk factors of their appearance in patients undergoing totally extraperitoneal (TEP) inguinal hernioplasty. METHODS Data were collected retrospectively from patients who underwent TEP inguinal hernioplasty between June 2020 and December 2022. RESULTS A total of 251 patients were included in the study. Obturator hernias were found in 21 patients (8.4%). At admission, no patient presented clinical signs of an obturator hernia. There was a significant predominance of women in the obturator hernia compared to the non-obturator hernia group (28.6% vs. 10.9%, respectively, p=0.018). There was no correlation between age (p=0.479) and BMI (p=0.771) and the occurrence of obturator hernia. Additional obturator hernia repair within the TEP inguinal hernioplasty procedure did not influence the overall length of the surgery (60.86 minutes) compared to the standard TEP inguinal hernioplasty (61.09 minutes, p=0.876). CONCLUSIONS The TEP inguinal hernioplasty allows the detection and repair of incidental obturator hernia. Through thorough inspection of the obturator canal, an asymptomatic obturator hernia can be detected and adequately treated within the same procedure, without the impact on the surgery duration, when performed by an experienced hernia surgeon.
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Affiliation(s)
- Jacek Bialecki
- Department of General Minimally Invasive and Trauma Surgery, Francis Raszeja Municipal Hospital, Mickiewicza 2 Street, 60-834, Poznan, Poland.
| | - Ryszard Antkowiak
- Department of General and Oncologic Surgery, St. Joseph Hospital, Mikolow, Poland
| | - Marcin Adamiecki
- Department of General and Oncologic Surgery, St. Joseph Hospital, Mikolow, Poland
| | - Anna Kasperczuk EngD
- Faculty of Mechanical Engineering, Institute of Biomedical Engineering, Bialystok University of Technology, Bialystok, Poland
| | - Lukasz Antkowiak
- Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Mateusz Szmit
- Department of General Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Pawel Domoslawski
- Department of General Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
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Salazar-Rios E, Cruz Olascoaga A. The "Little-Old-Lady's Hernia", Obturator Hernia: A Case Report and Literature Review. Case Rep Surg 2024; 2024:1039438. [PMID: 39015132 PMCID: PMC11250703 DOI: 10.1155/2024/1039438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 07/18/2024] Open
Abstract
Obturator hernias, though rare, are clinically significant abdominal hernias, predominantly affecting elderly, thin women, with an estimated prevalence of less than 1%. The primary treatment involves surgical intervention to reduce and repair the defect, either through laparotomy or laparoscopy, with bowel resection needed in up to 75% of patients. Here, we present the case of an 83-year-old woman presenting with abdominal pain and a history of constipation. An abdominal computed tomography scan demonstrated a left obturator hernia with small bowel obstruction. Successful reduction of the hernia was achieved, albeit requiring intestinal resection via an open surgical approach. Subsequently, the patient achieved complete recovery.
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Affiliation(s)
- Enrique Salazar-Rios
- División de Estudios de PosgradoFacultad de MedicinaUniversidad Nacional Autónoma de México, México City, Mexico
- Departamento de GastrocirugíaHospital de Especialidades “Dr. Bernardo Sepúlveda Gutiérrez” Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social, México City, Mexico
| | - Alexa Cruz Olascoaga
- Unidad Médica de Alta EspecialidadHospital de Gineco Obstetricia No. 3 “Dr. Víctor Manuel Espinosa de los Reyes Sánchez” Centro Médico Nacional la RazaInstituto Mexicano del Seguro Social, México City, Mexico
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Bhujel S, Adhikari S, Pant P, Pandey A, Baral BR, Chhetri ST. Obturator hernia: a persisting clinical diagnostic challenge - a case report. Ann Med Surg (Lond) 2024; 86:3698-3701. [PMID: 38846839 PMCID: PMC11152798 DOI: 10.1097/ms9.0000000000002073] [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: 01/15/2024] [Accepted: 04/07/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction The presentation of a strangulated obturator hernia is rare, with it accounting for less than 0.04% of all hernias. Delay in presentation and diagnosis results in complications like bowel ischemia, necrosis, perforation, and peritonitis, thereby increasing morbidity and mortality. Case presentation The authors report the case of an 85-year-old multiparous woman who presented with a 3-day history of abdominal pain and vomiting. Upon examination, she exhibited hypotension, altered sensorium, and a distended abdomen with visible peristalsis. An abdominal pelvic computed tomography scan confirmed the diagnosis of 'intestinal obstruction secondary to an incarcerated obturator hernia'. Subsequently, a lower midline laparotomy was performed, successfully reducing the bowel and repairing the hernial orifice. The patient was discharged on the fourth postoperative day, and there has been no hernia recurrence as of her 3-month follow-up. Discussion The presentation of a strangulated obturator hernia can be elusive. During clinical examination, both the Howship-Romberg sign and the Hannington-Kiffs sign tests may be negative. Laparoscopic obturator hernia repair has been shown to reduce hospital stay and morbidity. A midline laparotomy has the advantage of easy manual reduction, minimizing bowel trauma, accurately accessing the bowel, and facilitating bowel resection. Conclusion Obturator hernias constitute rare subtypes of abdominal hernias. They typically occur in older women, and patients often present with poor functional status and multiple comorbidities. The clinical diagnostic tests are uncertain, even in patients with a high index of suspicion. Timely diagnosis and appropriate surgical management are crucial for a favorable outcome.
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Affiliation(s)
- Sushim Bhujel
- College of Medical Sciences – Teaching Hospital, Bharatpur
| | | | - Prashant Pant
- Nepalese Army Institute of Health Sciences, Kathmandu
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Jung S, Lee HS. Robotic transabdominal preperitoneal repair for bilateral obturator hernia: a video vignette. JOURNAL OF MINIMALLY INVASIVE SURGERY 2024; 27:40-43. [PMID: 38494185 PMCID: PMC10961231 DOI: 10.7602/jmis.2024.27.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 03/19/2024]
Abstract
Obturator hernias (OHs) are a rare cause of bowel obstruction that requires immediate surgical intervention to prevent morbidity and mortality. Patients with OHs present with acute intestinal obstruction secondary to incarceration, with a high morbidity and mortality rate due to delayed diagnosis and treatment. Although several surgical approaches have been reported, a standard approach for OH treatment has not yet been established. Here, we report the case of a 74-year-old woman who presented with bilateral OHs. The patient presented at our institution with pain in the left lower quadrant. Computed tomography revealed preperitoneal fat in both obturator foramen. Robotic transabdominal preperitoneal (R-TAPP) bilateral OH repair was performed, and a mesh was placed over both obturator foramen. The patient recovered without postoperative complications and was discharged on postoperative day 2. This suggests that the R-TAPP approach is safe for OH repair without incarceration.
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Affiliation(s)
- Sungwoo Jung
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyung Soon Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Tokoyoda T, Inagaki T, Aoki Y, Okamoto T, Nakajima T, Teramoto K. Obturator Hernia in a Patient Undergoing Hemodialysis. Intern Med 2024; 63:97-100. [PMID: 36927970 PMCID: PMC10824643 DOI: 10.2169/internalmedicine.1388-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/20/2023] [Indexed: 03/18/2023] Open
Abstract
Obturator hernia is a rare condition that commonly affects frail older women. A 54-year-old woman presented to our hospital with left hip joint pain. She had suffered a left pubic bone fracture and commenced maintenance hemodialysis. Pelvic computed tomography (CT) showed an incarcerated small intestine through the left obturator foramen, while abdominal CT showed marked intestinal dilatation. She underwent emergency laparotomy, and the incarcerated small intestine was found to be necrotic. Partial small intestinal resection and bilateral obturator hernioplasty were performed. Because obturator hernia is a potentially fatal condition, early detection and treatment are important.
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Affiliation(s)
| | | | - Yuki Aoki
- Department of Nephrology, Nagoya Ekisaikai Hospital, Japan
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Velumani Y, Kumar N, Singh K, Naik MM, Basu S. Intestinal Obstruction Due to an Incarcerated Obturator Hernia: A Case Report and Review of the Literature. Cureus 2023; 15:e51382. [PMID: 38292986 PMCID: PMC10825814 DOI: 10.7759/cureus.51382] [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] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
An obturator hernia (OH) is a rare form of pelvic hernia in which the abdominal contents protrude through the obturator canal. Malnourished, frail, and multiparous elderly females are at risk of an OH. Preoperative diagnosis of obturator hernia is challenging because of non-specific symptoms. Most of the cases of OH reported in the literature are diagnosed during a laparotomy for acute intestinal obstruction. However, a contrast-enhanced computed tomography (CECT) scan of the abdomen is the best diagnostic investigation for OH. The morbidity and mortality are high because of the associated complications. We report a case of an obturator hernia in a 79-year-old cachectic female with features of acute intestinal obstruction and the usefulness of a CT scan in the preoperative diagnosis. Early diagnosis and treatment are the keys to preventing disastrous complications.
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Affiliation(s)
- Yogapriya Velumani
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Navin Kumar
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Karamveer Singh
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - M Murali Naik
- Radiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Somprakas Basu
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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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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9
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Burla MM, Gomes CP, Calvi I, Oliveira ESC, Hora DAB, Mao RD, de Figueiredo SMP, Lu R. Management and outcomes of obturator hernias: a systematic review and meta-analysis. Hernia 2023:10.1007/s10029-023-02808-w. [PMID: 37270718 DOI: 10.1007/s10029-023-02808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Obturator Hernia (OH) is a rare type of abdominal wall hernia. It usually occurs in elderly women with late symptomatic presentation, increasing mortality rates. Surgery is the standard of care for OH, and laparotomy with simple suture closure of the defect is commonly used. Given the rarity of this disease, large studies are lacking, and data to drive management are still limited. This systematic review and meta-analysis aimed to describe current surgical options for OHs, with a focus on comparing the effectiveness and safety of mesh use with primary repair. METHODS PubMed, EMBASE, and Cochrane were searched for studies comparing mesh and non-mesh repair for OH. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. RESULTS One thousand seven hundred and sixty studies were screened and sixty-seven were thoroughly reviewed. We included 13 observational studies with 351 patients surgically treated for OH with mesh or non-mesh repair. One hundred and twenty (34.2%) patients underwent mesh repair and two hundred and thirty-one (65.81%) underwent non-mesh repair. A total of 145 (41.3%) underwent bowel resection, with the majority having a non-mesh repair performed. Hernia recurrence was significantly higher in patients who underwent hernia repair without mesh (RR 0.31; 95% CI 0.11-0.94; p = 0.04). There were no differences in mortality (RR 0.64; 95% CI 0.25-1.62; p = 0.34; I2 = 0%) or complication rates (RR 0.59; 95% CI 0.28-1.25; p = 0.17; I2 = 50%) between both groups. CONCLUSION Mesh repair in OH was associated with lower recurrence rates without an increase in postoperative complications. While mesh in clean cases is more likely to offer benefits, an overall recommendation regarding its use in OH repair cannot be made due to potential bias across studies. Given that many OH patients are frail and present emergently, the decision to use mesh is complex and should consider the patient's clinical status, comorbidities, and degree of intraoperative contamination.
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Affiliation(s)
- M M Burla
- Department of Medicine, Estacio de Sa Vista Carioca University, RJ, Rio de Janeiro, Brazil.
| | - C P Gomes
- Department of Obstetrics and Gynecology, Maimonides Medical Center, New York, NY, USA
| | - I Calvi
- Department of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, KGD, Russian Federation
| | - E S C Oliveira
- Department of Medicine, University of Brasilia, Brasilia, DF, Brazil
| | - D A B Hora
- Department of Medicine, Federal University of Amazonas, Manaus, AM, Brazil
| | - R D Mao
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - S M P de Figueiredo
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - R Lu
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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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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Ibrahim YW, Tabi P, Yusuf A. A Rare Cause of Medial Thigh Pain: Does Point-of-Care Ultrasound Scan Have a Role in the Diagnosis of Obturator Hernia in the Emergency Room? Cureus 2023; 15:e33547. [PMID: 36779097 PMCID: PMC9907379 DOI: 10.7759/cureus.33547] [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] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Obturator hernia describes the protrusion of the intra-abdominal viscus through the obturator foramen. It accounts for 0.05-1.4% of all hernias. We present a case of a 72-year-old female, with right-sided inner thigh pain of sudden onset who was subsequently diagnosed with an obturator hernia in the emergency room with point-of-care ultrasound (POCUS). She subsequently had laparoscopic surgery and improved without complications.
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Affiliation(s)
- Yakub W Ibrahim
- Emergency Medicine, Mid and South Essex University Hospital NHS Trust, Southend-On-Sea, GBR
| | - Philip Tabi
- Emergency Medicine, Mid and South Essex University Hospital NHS Trust, Southend-On-Sea, GBR
| | - Abdurrahman Yusuf
- Emergency Medicine, Mid and South Essex University Hospital NHS Trust, Southend-On-Sea, GBR
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Traumatic obturator foramen hernia. A rare aetiology of a rare condition: A case report. Trauma Case Rep 2022; 39:100635. [PMID: 35340355 PMCID: PMC8942845 DOI: 10.1016/j.tcr.2022.100635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/21/2022] Open
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13
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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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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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OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac044. [PMID: 35198147 PMCID: PMC8860489 DOI: 10.1093/jscr/rjac044] [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: 12/09/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Obturator hernia is a pelvic floor type of hernia in which abdominal or pelvic contents protrude through the obturator foramen. It is considered rare in patients with signs and symptoms of intestinal obstruction causing a diagnostic challenge for clinicians. This case reports a 91-year-old multiparous female who presented with vague lower abdominal pain associated with obstipation and vomiting. We present a successful laparoscopic repair of obturator hernia in an elderly female.
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Barbosa BRDS, Pinto JCP, Duarte L, Marques J, Casimiro C. Small Bowel Obstruction Due to Incarcerated Obturator Hernia: Successfull Surgical Management with Modified Mesh-Plug Hernioplasty. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931398. [PMID: 34344857 PMCID: PMC8351299 DOI: 10.12659/ajcr.931398] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obturator hernia is an uncommon (0.07-1% incidence rate) subtype of hernia of the abdominal wall, with its incarceration being a rare cause of bowel obstruction. Obturator hernia has a higher incidence in elderly women and in malnourished people. This type of hernia has the highest morbidity and mortality rates of all abdominal wall hernias. This article reports a case of an emaciated 93-year-old woman who presented with small bowel obstruction due to incarcerated obturator hernia, successfully managed surgically with a modified mesh-plug hernioplasty. CASE REPORT An emaciated 93-year-old woman presented with diffuse abdominal pain, more intense on the right iliac fossa, radiating to the right thigh, with 8-h evolution and associated with dark-colored vomiting but normal bowel transit. This patient had a surgical history of right Richter´s femoral hernia, strangulated, with previous intestinal resection and a right femoral hernioplasty. A computed tomography (CT) scan revealed an incarcerated obturator hernia on the right side containing a short segment of small intestine. The patient underwent an exploratory laparotomy and a mesh-plug hernioplasty. During follow-up, there was no evidence of recurrence or complications. CONCLUSIONS Obturator hernia diagnosis is challenging due to its rarity and its signs and symptoms being often unspecific. CT scan has the highest sensitivity and is the best diagnostic tool. Surgical management is the only possible treatment for obturator hernia. Awareness of this condition is essential to allow an earlier approach and attempt to mitigate the associated high morbidity and mortality rates.
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Affiliation(s)
| | | | - Liliana Duarte
- Department of General Surgery, Hospital Center Tondela-Viseu, Viseu, Portugal
| | - Júlio Marques
- Department of General Surgery, Hospital Center Tondela-Viseu, Viseu, Portugal
| | - Carlos Casimiro
- Department of General Surgery, Hospital Center Tondela-Viseu, Viseu, Portugal
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