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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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3
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Zhao M, Han H, Lu J. Successful treatment of strangulated obturator hernia: A case report. Asian J Surg 2024:S1015-9584(24)01368-X. [PMID: 38987125 DOI: 10.1016/j.asjsur.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/05/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
- Mingjian Zhao
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, PR China
| | - Haifeng Han
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, PR China
| | - Jinghui Lu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, PR China.
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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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5
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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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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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Garcia EM, Pietryga JA, Kim DH, Fowler KJ, Chang KJ, Kambadakone AR, Korngold EK, Liu PS, Marin D, Moreno CC, Panait L, Santillan CS, Weinstein S, Wright CL, Zreloff J, Carucci LR. ACR Appropriateness Criteria® Hernia. J Am Coll Radiol 2022; 19:S329-S340. [PMID: 36436960 DOI: 10.1016/j.jacr.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Abdominopelvic hernias are common clinical entities composed of a wide variety of congenital, traumatic, and iatrogenic etiologies. Any weakness in the body wall may result in hernia of cavity contents with concomitant risks of morbidity and mortality. Presentations may be specific, palpable body wall mass/bulge, or vague, nonspecific pain through bowel obstruction. This document focuses on initial imaging of the adult population with signs of symptoms prompting suspicion of abdominopelvic hernia. Imaging of the abdomen and pelvis to evaluate defects is essential for prompt diagnosis and treatment. Often CT and ultrasound are the first-line modalities to quickly evaluate the abdomen and pelvis, providing for accurate diagnoses and management of patients. MRI protocols may be useful as first-line imaging studies, especially in patients with orthopedic instrumentation. Although often performed, abdominal radiographs and fluorographic procedures may provide indirect evidence of hernias but are usually not indicated for initial diagnosis of hernia. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Board Member, Taubman Museum of Art.
| | - Jason A Pietryga
- Division Chief, Emergency Radiology at UNC Chapel Hill, Chapel Hill North Carolina; and University of Alabama at Birmingham, Birmingham, Alabama
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin; and Vice-Chair of Education, University of Wisconsin Department of Radiology
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; Chair ACR LI-RADS; Division Chief, SAR Portfolio Director, RSNA Radiology Senior Deputy Editor
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts; Section Chief of Abdominal Imaging, Director of MRI, Chair of Committee on C-RADS
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Division Chief, Abdominal Imaging, Massachusetts General Hospital and Medical Director, Martha's Vineyard Hospital Imaging
| | - Elena K Korngold
- Section Chief, Body Imaging/Chair, Department of Radiology Promotion and Tenure Committee; Oregon Health and Science University, Portland, Oregon
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Lucian Panait
- President, Minnesota Hernia Center, Minneapolis, Minnesota; American College of Surgeons; American Hernia Society (member of the Technology and Value Assessment Committee); Practice Advisory Committee Member, American Hernia Society
| | - Cynthia S Santillan
- Vice-Chair of Clinical Operations, Department of Radiology, University of California San Diego, San Diego, California
| | | | | | - Jennifer Zreloff
- Georgia, Primary Care Physician, Emory University, Atlanta, Georiga; Medical Director, Seavey General Medicine Clinic; Assistant Director of Innovation Seavey Comprehensive Internal Medicine Clinic, Emory University, Atlanta, Georgia
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Section Chief Abdominal Imaging, Director of MRI and CT
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8
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Sun K, Wu Y. Mechanical intestinal obstruction in underweight, elderly women due to an incarcerated obturator hernia. ANZ J Surg 2022; 92:2534-2537. [DOI: 10.1111/ans.18035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/20/2022] [Accepted: 08/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ke‐kang Sun
- Department of Gastrointestinal Surgery Affiliated Kunshan Hospital to Jiangsu University Suzhou Jiangsu China
- Department of Gastrointestinal Surgery The Second Affiliated Hospital of Soochow University Suzhou Jiangsu China
| | - Yong‐you Wu
- Department of Gastrointestinal Surgery The Second Affiliated Hospital of Soochow University Suzhou Jiangsu China
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Fukuyama Y, Toda K, Funakoshi H. Recurrent abdominal pain in an older woman: Enlarged OE-P gap on computed tomography as an indicator of non-strangulated obturator hernia. J Am Coll Emerg Physicians Open 2022; 3:e12803. [PMID: 35978656 PMCID: PMC9365236 DOI: 10.1002/emp2.12803] [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: 01/25/2022] [Revised: 07/15/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
Obturator hernia (OH) is a relatively rare abdominal wall hernia with a high mortality rate. The diagnosis of OH is challenging because of symptomatic variations and spontaneous reduction in hernia on imaging. An 89-year-old woman presented to our emergency department with pain in the abdomen and right groin. Computed tomography (CT) revealed an incarcerated small bowel in the gap between the obturator externus and pectineus (OE-P gap). Symptoms disappeared after manual reduction. She experienced these same symptoms intermittently during the past year and underwent abdominal CT 4 times after disappearance of symptoms. The CT scans at each previous visit showed an enlarged OE-P gap (an average of 80 mm) compared with the asymptomatic side (an average of 34 mm). An enlarged OE-P gap on CT images taken after disappearance of symptoms could be a sign of spontaneously reduced OH.
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Affiliation(s)
- Yuita Fukuyama
- Department of Emergency and Critical Care MedicineTokyo Bay Urayasu IchikawaMedical CenterUrayasuChibaJapan
- Shock and Trauma CenterNippon Medical School Chiba Hokusoh HospitalInzaiChibaJapan
| | - Kazuki Toda
- Department of Emergency and Critical Care MedicineTokyo Bay Urayasu IchikawaMedical CenterUrayasuChibaJapan
- Department of Emergency MedicineShizuoka Medical CenterNagasawa, Suntogun ShimizuchoShizuokaJapan
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care MedicineTokyo Bay Urayasu IchikawaMedical CenterUrayasuChibaJapan
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Zhang Z, Yuan J, Gu Z, Tu Z, Huang W, Shen G. The Feasibility and Potential Advantages of Laparoscopic Management of Incarcerated Obturator Hernia Over the Open Approach. Surg Laparosc Endosc Percutan Tech 2021; 32:241-246. [PMID: 34966155 DOI: 10.1097/sle.0000000000001029] [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: 05/16/2021] [Accepted: 10/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to explore the feasibility and potential advantages of laparoscopic surgery in the treatment of incarcerated obturator hernia (IOH). MATERIALS AND METHODS Clinical data of 23 patients with IOH who underwent emergency surgery at our hospital from June 2015 to October 2020 were retrospectively analyzed. The clinical characteristics and surgery outcomes were compared between the laparoscopic group, open group, and the previously published data. RESULTS Twelve patients with IOH were treated by laparoscopic management, while 11 patients with IOH underwent open surgery. There was no statistically significant difference in preoperative general data between the 2 groups, while the laparoscopic group had less intraoperative blood loss, shorter postoperative hospital stay, and lower postoperative complications compared with open group. Furthermore, when compared with the open group reported in previous literature, which showed similar conclusions. CONCLUSION Laparoscopic surgery for IOH showed more favorable advantages including less intraoperative blood loss, shorter postoperative hospital stay, and lower postoperative complications compared with an open approach, which is a safe and feasible minimally invasive strategy and has certain advantages.
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Affiliation(s)
- Zhi Zhang
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
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11
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Hori T, Yasukawa D. Fascinating history of groin hernias: Comprehensive recognition of anatomy, classic considerations for herniorrhaphy, and current controversies in hernioplasty. World J Methodol 2021; 11:160-186. [PMID: 34322367 PMCID: PMC8299909 DOI: 10.5662/wjm.v11.i4.160] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/02/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, femoral, obturator, and supravesical hernias. Here, we summarize historical turning points, anatomical recognition and surgical repairs. Groin hernias have a fascinating history in the fields of anatomy and surgery. The concept of tension-free repair is generally accepted among clinicians. Surgical repair with mesh is categorized as hernioplasty, while classic repair without mesh is considered herniorrhaphy. Although various surgical approaches have been developed, the surgical technique should be carefully chosen for each patient. Regarding as interesting history, crucial anatomy and important surgeries in the field of groin hernia, we here summarized them in detail, respectively. Points of debate are also reviewed; important points are shown using illustrations and schemas. We hope this systematic review is surgical guide for general surgeons including residents. Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.
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Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
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12
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Diab J, Badiani S, Berney CR. A decade review of emergency obturator hernia repairs. ANZ J Surg 2021; 91:1596-1603. [PMID: 34125472 DOI: 10.1111/ans.17011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Obturator hernia is a rare pelvic hernia associated with a high morbidity and mortality. It most commonly occurs in elderly, multiparous females with symptoms and signs of small bowel obstruction. We present an Australian hospital network experience on emergency presentations of obturator hernias highlighting differences between clinical profile and surgical management. METHODS A retrospective review of adult patients diagnosed with acute obturator hernia during a 10 year period (2010-2020) was conducted across 10 major Sydney hospitals in New South Wales, Australia. RESULTS Obturator hernia was diagnosed in 18 patients (mean 82.7 years, range: 60-96 years old), all confirmed on pre-operative computed tomography imaging. The most common presentations were elderly women demonstrating clinical features of a small bowel obstruction. The mean onset of symptoms from home to hospital admission was 49.4 h. Non-survivors had a significantly elevated urea level (15.6 vs. 7.8 mmol/L, p = 0.036) at presentation and a longer delay from onset of presenting symptoms to diagnosis (84.0 vs. 36.2 h, p = 0.028). Eleven patients underwent urgent laparotomy and six laparoscopic repairs. The mean operative time was 101.0 min. The average hospital length of stay was 16.2 days with a mortality rate of 27.8%. CONCLUSION Timely diagnosis and operative intervention for obturator hernia is the cornerstone of management.
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Affiliation(s)
- Jason Diab
- Bankstown Lidcombe Hospital, Bankstown, New South Wales, Australia.,University of Notre Dame, School of Medicine, Sydney, New South Wales, Australia.,University of New South Wales, School of Medicine, Sydney, New South Wales, Australia
| | - Sarit Badiani
- Bankstown Lidcombe Hospital, Bankstown, New South Wales, Australia.,University of New South Wales, School of Medicine, Sydney, New South Wales, Australia
| | - Christophe R Berney
- Bankstown Lidcombe Hospital, Bankstown, New South Wales, Australia.,University of New South Wales, School of Medicine, Sydney, New South Wales, Australia
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13
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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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Obturator hernias: a systematic review of the literature. Hernia 2020; 25:193-204. [PMID: 32772276 DOI: 10.1007/s10029-020-02282-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/27/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Obturator hernias (OH) are extremely rare hernias, accounting for 0.07-1% of all hernias. This is the first systematic review investigating their presentation, imaging, treatment outcomes, and recurrence rate. METHODS After a detailed search in electronic search engines, 74 studies matched our criteria. A review of these reports was conducted and the full texts were examined. RESULTS A total of 146 patients with a mean age of 78.8 years were included in our analysis, with 40.1%, 29.9%, and 25.2% of patients suffering from either a right, a left or bilateral OH, respectively. OH were associated with non-specific symptoms and signs; bowel obstruction being the most common. Howship-Romberg sign was present in 56.2% of patients. Computed tomography (CT) scan was the most frequently used diagnostic modality, inversely associated with perioperative mortality. Mesh repair demonstrated a significantly improved perioperative morbidity rate, compared with non-mesh repair. Approximately 30% of patients underwent a laparoscopic operation, which was associated with significantly decreased morbidity and mortality rate as well as length of hospital stay, compared with the open repair. CONCLUSION OHs are not associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair.
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Amiki M, Goto M, Tomizawa Y, Sugiyama A, Sakon R, Inoue T, Ito S, Oneyama M, Shimojima R, Hara Y, Narita K, Tachimori Y, Sekikawa K. Laparoscopic transabdominal preperitoneal hernioplasty for recurrent obturator hernia: A case report. Asian J Endosc Surg 2020; 13:457-460. [PMID: 31332930 DOI: 10.1111/ases.12739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/30/2019] [Accepted: 07/03/2019] [Indexed: 12/12/2022]
Abstract
Reports of recurrence after obturator hernia repair are few. We describe the case of an 89-year-old woman who presented to us with a thrice recurrent obturator hernia. She had undergone open non-mesh repair twice and then laparoscopic non-mesh repair. She was readmitted to our hospital 6 months after the laparoscopic repair. Manual reduction was successful, paving the way for elective transabdominal preperitoneal repair. During the endoscopic repair, surgical mesh was placed extraperitoneally over the hernia defect and then fixed to Cooper's ligament with absorbable tacks. The patient was discharged on postoperative day 2 without complications. In the 2 months that have passed since the surgery there has been no sign of recurrence, but the patient will be carefully followed up. Repair of a recurrent obturator hernia is technically challenging; however, the transabdominal preperitoneal approach seems to be reliable and safe.
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Affiliation(s)
- Manabu Amiki
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Manabu Goto
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yuki Tomizawa
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | | | - Ryota Sakon
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Takahiro Inoue
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Shingo Ito
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Masataka Oneyama
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Reiko Shimojima
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yoshiaki Hara
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Kazuhiro Narita
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yuji Tachimori
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Koji Sekikawa
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
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16
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Kwak JS, Lee SE, Park SM, Lee SJ, Kwon SU, Bae IE, Sung NS, Moon JI, Yoon DS, Choi IS, Choi WJ. Which Patients Are a Better Candidate of Laparoscopic Repair in Obturator Hernia Patients? JOURNAL OF MINIMALLY INVASIVE SURGERY 2020; 23:93-98. [PMID: 35600059 PMCID: PMC8985633 DOI: 10.7602/jmis.2020.23.2.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/24/2020] [Accepted: 04/20/2020] [Indexed: 06/15/2023]
Abstract
PURPOSE Obturator hernia is a difficult disease to diagnose. If a surgical treatment is delayed in obturator hernia, a bowel resection may be required due to strangulation. The surgical treatment of this disease is to use a classical laparotomy. Recently, the laparoscopic approach has been reported and reviewed for efficiency. We checked the indicators that determine the most appropriate surgical method according to the patient's condition. METHODS In the study, a single-institution, retrospective analysis of surgical patients undergoing an obturator hernia surgery between 2003 and 2018 was performed. The patients were divided into a laparoscopic group (5 patients underwent laparoscopic repair; no intestinal resection) and an open group (13 patients who underwent open repair; 10 with and 3 without intestinal resection). The outcomes were compared between the groups. We analyzed the relevant factors that could predict the proper method of surgery. RESULTS A total 18 patients were included in the study. All patients were female, with body mass index (BMI) of under 21 kg/m2. Of the various factors, only the WBC and CRP counts were the factors that had shown significant differences between the two groups. It is noted that patients with open surgery had a higher WBC counts (10406 versus 6520/μl; p=0.011) and CRP counts (7.84 vs. 0.32 mg/dl; p=0.027). CONCLUSION Obturator hernia can be treated with a laparoscopic surgery. The choice of surgical treatment can be considered in advance through the review of the patient's WBC count or CRP count.
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Affiliation(s)
- Jae Seung Kwak
- Department of General Surgery, Konyang University Hospital, Daejeon, Korea
| | - Sang Eok Lee
- Department of General Surgery, Konyang University Hospital, Daejeon, Korea
| | - Si Min Park
- Department of General Surgery, Konyang University Hospital, Daejeon, Korea
| | - Seung Jae Lee
- Department of General Surgery, Konyang University Hospital, Daejeon, Korea
| | - Seong Uk Kwon
- Department of General Surgery, Konyang University Hospital, Daejeon, Korea
| | - In Eui Bae
- Department of General Surgery, Konyang University Hospital, Daejeon, Korea
| | - Nak Song Sung
- Department of General Surgery, Konyang University Hospital, Daejeon, Korea
| | - Ju Ik Moon
- Department of General Surgery, Konyang University Hospital, Daejeon, Korea
| | - Dae Sung Yoon
- Department of General Surgery, Konyang University Hospital, Daejeon, Korea
| | - In Seok Choi
- Department of General Surgery, Konyang University Hospital, Daejeon, Korea
| | - Won Jun Choi
- Department of General Surgery, Konyang University Hospital, Daejeon, Korea
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Hosoi Y, Asano H, Fukano H, Shinozuka N. Treatment outcomes of Kugel repair for obturator hernias: a retrospective study. BMC Surg 2020; 20:131. [PMID: 32532257 PMCID: PMC7291628 DOI: 10.1186/s12893-020-00795-8] [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: 09/10/2019] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background We examined the validity and applicability of the Kugel repair approach for obturator hernias, whereby we placed a Kugel patch through the preperitoneal space after placing a short 5-cm skin incision just medial to the anterior iliac spine and 2 cm cranial to the expected origin of the internal inguinal ring. Methods We studied patients who underwent surgical Kugel repair for obturator hernias at the Department of General Surgery, Saitama Medical University between 2007 and 2017. We examined the operating time, length of hospital stay, postoperative complications, and mortality rate. Results Fifty-eight patients with obturator hernias presented with symptoms of small bowel obstruction. A Kugel approach was used in 53 patients and a midline approach was used in 5 patients with preoperative peritonitis. Of the 53 patients managed using the Kugel approach, 39 did not require intestinal resection; a mesh was used in all these patients. In the remaining 14 patients, intestinal resection was required and performed using the same approach; subsequently, a mesh was used successfully in 6 of these 14 patients. The overall median operating time was 47 min; the corresponding values for procedures with and without intestinal resection were 39 and 68 min, respectively. In terms of postoperative complications, operative mortality was not noted among patients without intestinal perforation; however, superficial surgical site infection developed in 2 patients. Among the 5 patients with preoperative peritonitis who underwent exploratory laparotomy via a midline incision, intestinal perforation was detected during surgery, and all patients required intestinal resection; none of the patients had received a mesh, and 2 patients died after surgery. Conclusions The Kugel repair approach was possible even in patients with obturator hernia requiring intestinal resection. However, for patients with perforations, open surgery should be performed after securing the surgical field through a midline incision.
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Affiliation(s)
- Yoshie Hosoi
- Department of General Surgery, Saitama Medical University, 38 Morohongou, Moroyama, Irumagun, Saitama, 350-0495, Japan
| | - Hiroshi Asano
- Department of General Surgery, Saitama Medical University, 38 Morohongou, Moroyama, Irumagun, Saitama, 350-0495, Japan.
| | - Hiroyuki Fukano
- Department of General Surgery, Saitama Medical University, 38 Morohongou, Moroyama, Irumagun, Saitama, 350-0495, Japan
| | - Nozomi Shinozuka
- Department of General Surgery, Saitama Medical University, 38 Morohongou, Moroyama, Irumagun, Saitama, 350-0495, Japan
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Zhou YX, Ji Y, Lv J. Small bowel obstruction secondary to obturator hernia. ANZ J Surg 2019; 90:1195-1197. [PMID: 31625255 DOI: 10.1111/ans.15520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/08/2019] [Indexed: 10/25/2022]
Affiliation(s)
- You-Xin Zhou
- Department of General Surgery, Jingjiang People's Hospital, Medical School of Yangzhou University, Taizhou, China
| | - Yong Ji
- Department of General Surgery, Jingjiang People's Hospital, Medical School of Yangzhou University, Taizhou, China
| | - Jian Lv
- Department of General Surgery, Jingjiang People's Hospital, Medical School of Yangzhou University, Taizhou, China
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19
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Rubay D, Ohanisian L, Shin R, Hristov B, Yeguez J. Asynchronous Bilateral Obturator Hernias: A Suggested Approach to Reduce Morbidity of Obturator Hernias. Cureus 2019; 11:e5260. [PMID: 31463166 PMCID: PMC6701889 DOI: 10.7759/cureus.5260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Obturator hernias (OHs) are rare pelvic hernias that involve the protrusion of intraperitoneal or extraperitoneal organs or tissues through the obturator foramen. Risk factors for OH patients include female gender, chronic disease, age, malnourishment, history of multiple pregnancies, anatomical enlargement of obturator foramen, increased intraabdominal pressure, and defective collagen metabolism. Since OHs have the highest mortality rate of all abdominal hernias, prompt diagnosis and treatment are critical. Prior research has demonstrated an increased likelihood of bilateral OHs relative to unilateral. We present the case of a 79-year-old female who presented with an obstructed OH six months after an operation for an OH on the contralateral side. Due to the potential morbidity and mortality associated with OHs and delay in discovery, we suggest evaluation and treatment of the contralateral side in patients who present with unilateral OHs.
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Affiliation(s)
- David Rubay
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Levonti Ohanisian
- Orthopaedic Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Rebecca Shin
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Boris Hristov
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Jose Yeguez
- Surgery, Florida Atlantic University School of Medicine, Boca Raton, USA
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20
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Memon ZA, Aisha M, Qadar LT, Ochani RK, Ali Asghar S. Rare Case of Peritonitis due to Ileal Perforation Secondary to Richter's Type of Obturator Hernia. Cureus 2019; 11:e4289. [PMID: 31183270 PMCID: PMC6538228 DOI: 10.7759/cureus.4289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Obturator hernia is an extremely rare condition accounting for almost 0.07%-1% of all abdominal wall hernias, usually occurring in the elderly and emaciated females with a history of previous abdominal surgery. The symptoms of this particular hernia are non-specific; therefore, a high index of clinical suspicion should always be made. This rare condition may lead to acute small intestinal obstruction. The pre-operative diagnosis is challenging and often misleading on occasions, especially in co-morbid cases. This leads to delayed diagnosis and surgical intervention, hence causing an increased morbidity and mortality rate. The computed tomography (CT) scan of the abdomen and pelvis is the gold standard for diagnosis. We present a case of an 80-year-old female, with known comorbid of hypertension, initially diagnosed as peritonitis and on further examination revealed strangulated obturator hernia with proximal perforation, that underwent lower midline laparotomy with resection of necrotic bowel, an end-to-end anastomosis, and repair of the defect by vicryl suture.
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Affiliation(s)
| | - Maria Aisha
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Laila Tul Qadar
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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21
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Rastogi V, Singh D, Tekiner H, Ye F, Mazza JJ, Yale SH. Abdominal Physical Signs and Medical Eponyms: Movements and Compression. Clin Med Res 2018; 16:76-82. [PMID: 30587562 PMCID: PMC6306146 DOI: 10.3121/cmr.2018.1422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/25/2018] [Accepted: 09/26/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prior to the advent of modern imaging techniques, maneuvers were performed as part of the physical examination to further assess pathological findings or an acute abdomen and to further improve clinicians' diagnostic acumen to identify the site and cause of disease. Maneuvers such as changing the position of the patient, extremity, or displacing through pressure a particular organ or structure from its original position are typically used to exacerbate or elicit pain. Some of these techniques, also referred to as special tests, are ascribed as medical eponym signs. DATA SOURCES PubMed, Medline, online Internet word searches, textbooks and references from other source text. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign. CONCLUSION These active and passive maneuvers of the abdomen, reported as medical signs, have variable performance in medical practice. The lack of diagnostic accuracy may be attributed to confounders such as the position of the organ, modification of the original technique, or lack of performance of the maneuver as originally intended.
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Affiliation(s)
- Vaibhav Rastogi
- University of Central Florida, College of Medicine, Orlando, Florida, USA
| | - Devina Singh
- University of Florida, Department of Medicine, Gainesville, Florida, USA
| | - Halil Tekiner
- Department of the History of Pharmacy and Ethics, Erciyes University School of Pharmacy, Talas, Kayseri, Turkey
| | - Fan Ye
- University of Central Florida, College of Medicine, Orlando, Florida, USA
| | - Joseph J Mazza
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Steven H Yale
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
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22
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Obturator Hernia in Elderly Female Patients. Int Surg 2018. [DOI: 10.9738/intsurg-d-17-00023.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Obturator hernia (OH) constitutes 0.07% to 0.4% of all intraabdominal hernias and 0.2% to 5.8% of small intestinal hernias. OH is usually seen in elderly, multiparous females and patients with a low body weight. This multicenter study includes patients who were treated in Adnan Menderes University Medical Faculty Hospital, Bozyaka Education and Research Hospital and İnönü University Medical Faculty Hospital between January 2010 and June 2015. The diagnosis of OH was made preoperatively or perioperatively in patients who underwent emergency laparotomy for the treatment of ileus. A total of 14 patients were included in this study; 3 patients were treated by laparoscopic method (transabdominal approach) under general anesthesia and 2 of these patients (66.6%) died after the surgery. A total of 7 patients were treated by laparotomy. The remaining 4 patients were treated with a minimally invasive approach by using an epidural block without general anesthesia (3 patients with Pfannenstiel and 1 patient with a median inferior incision). The overall mortality rate was 42.8%. Anesthesia and surgery types have an important effect on mortality in elderly OH patients with multiple comorbidities. Minimally invasive approach with the use of epidural anesthesia can reduce the mortality rates in patients with OH. Abdominal computed tomography is the golden standard in the diagnosis of OH.
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23
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Impact of bowel resection on postoperative mortality in patients with obturator hernias. Hernia 2018; 23:317-322. [PMID: 30327983 DOI: 10.1007/s10029-018-1835-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 10/10/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to identify any potential correlation between postoperative mortality and bowel resection in patients with obturator hernias. METHODS In total, 21 patients who underwent emergency surgery for a primary incarcerated obturator hernia during a 9-year period were retrospectively assessed regarding the correlation between postoperative mortality within 30 days from surgery and bowel resection. RESULTS The 21 hernias occurred in 20 women and 1 man. The mean age at presentation was 83.3 years. Eight hernias required bowel resection, and operations using mesh were performed for eight hernias. Complications occurred in association with nine hernias, and three patients died. Postoperative mortality was correlated with complications (p = 0.016) and bowel resection (p = 0.010). Patients undergoing bowel resection had a significantly longer operation time (p = 0.009) and a higher rate of postoperative complications (p = 0.018). The systolic blood pressure, pH, and base excess were significantly lower in patients who did than did not undergo bowel resection (p = 0.017, 0.009, and 0.015, respectively). CONCLUSION As the aging population continues to expand, the number of patients with obturator hernias is speculated to increase. Elderly people with comorbidities require immediate operative procedures because their general condition tends to be exacerbated by bowel obstruction. Postoperative management may be carefully performed in patients with bowel resection because the postoperative mortality rates may be higher in these patients.
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Pavlidis E, Kosmidis C, Sapalidis K, Tsakalidis A, Giannakidis D, Rafailidis V, Koimtzis G, Kesisoglou I. Small bowel obstruction as a result of an obturator hernia: a rare cause and a challenging diagnosis. J Surg Case Rep 2018; 2018:rjy161. [PMID: 29992011 PMCID: PMC6030978 DOI: 10.1093/jscr/rjy161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 06/18/2018] [Indexed: 12/28/2022] Open
Abstract
Obturator hernias are exceedingly rare in surgical routine, constituting 0.073% of all intra-abdominal hernias in the West and 1% in the far East. Commonly known as 'little old lady's hernia', obturator hernias are usually seen in frail, octogenarian multiparous women. This case report discusses an 85-year-old female who had symptoms of acute bowel obstruction; thanks to high degree of clinical suspicion and aided by a computed tomography (CT) of abdomen and pelvis, an incarcerated right obturator hernia was diagnosed preoperatively and treated successfully. Obturator hernia is a rare condition associated with a high rate of morbidity and mortality. CT scan is the most accurate imaging method for pre-operative diagnosis. Early diagnosis and surgical intervention are fundamentals to lead to better outcomes for the patients.
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Affiliation(s)
- Efstathios Pavlidis
- Third Surgical Department, Aristotle University of Thessaloniki, Medical School, AHEPA University Hospital, Kyriakidi 1, Thessaloniki, Greece
| | - Christoforos Kosmidis
- Third Surgical Department, Aristotle University of Thessaloniki, Medical School, AHEPA University Hospital, Kyriakidi 1, Thessaloniki, Greece
| | - Konstantinos Sapalidis
- Third Surgical Department, Aristotle University of Thessaloniki, Medical School, AHEPA University Hospital, Kyriakidi 1, Thessaloniki, Greece
| | - Alexandros Tsakalidis
- Third Surgical Department, Aristotle University of Thessaloniki, Medical School, AHEPA University Hospital, Kyriakidi 1, Thessaloniki, Greece
| | - Dimitrios Giannakidis
- Third Surgical Department, Aristotle University of Thessaloniki, Medical School, AHEPA University Hospital, Kyriakidi 1, Thessaloniki, Greece
| | - Vasileios Rafailidis
- Department of Radiology, Aristotle University of Thessaloniki, Medical School, AHEPA University Hospital, Kyriakidi 1, Thessaloniki, Greece
| | - Georgios Koimtzis
- Third Surgical Department, Aristotle University of Thessaloniki, Medical School, AHEPA University Hospital, Kyriakidi 1, Thessaloniki, Greece
| | - Isaak Kesisoglou
- Third Surgical Department, Aristotle University of Thessaloniki, Medical School, AHEPA University Hospital, Kyriakidi 1, Thessaloniki, Greece
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25
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Wu TC, Lu Q, Liang XH. Efficacy of emergency exploratory laparotomy in incarcerated obturator hernia. Acta Chir Belg 2018; 118:105-109. [PMID: 29065783 DOI: 10.1080/00015458.2017.1394671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Incarcerated obturator hernia (IOH) is a scarce type of acute surgical disease, but the mortality rate is the highest in abdominal hernias. The aim of this study was to evaluate the efficacy of emergency exploratory laparotomy (EEL) in treating incarcerated obturator hernia (IOH). METHODS We conducted a retrospective study of 12 female patients with IOH underwent EEL between January 2014 and March 2016. The variables which included patient characteristics, findings of CT, operative time, postoperative complications, length of hospital stay, ICU admission rate, 30-day readmission rate and mortality were analyzed. RESULTS The age of patients was 82.5 ± 4.2 years and the median body mass index (BMI) was 20.6 kg/m2 (IQR, 18.7-21.5 kg/m2). There were 10 patients (83.3%) underwent partial intestinal resection due to partial small bowel necrosis or perforation. The total operation time was 85.7 ± 8.7 min. The time to initiation of a soft diet was 3.9 ± 0.7 days and the median length of stay was 15.0 days (IQR, 14.0-17.5 days), respectively. CONCLUSIONS The EEL is a clinically safe and necessary choice for early diagnosis and treatment in IOH. EEL may improve the curative effect of IOH significantly.
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Affiliation(s)
- Tian-Chong Wu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Medical College, Shenzhen People’s Hospital, Jinan University, Shenzhen, Guangdong Province, China
| | - Qiao Lu
- Department of Gastrointestinal Surgery, Huizhou Municipal Central Hospital, Affiliated Huizhou Hospital of Sun Yat-sun University, Huizhou, Guangdong Province, China
| | - Xiao-Hui Liang
- Department of Gastrointestinal Surgery, Huizhou Municipal Central Hospital, Affiliated Huizhou Hospital of Sun Yat-sun University, Huizhou, Guangdong Province, China
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Abstract
Obturator hernia (OH) is a rare condition that accounts for 0.073-1% of abdominal hernias and 0.48% of bowel obstructions. OH frequently occurs in elderly women, with an incidence that increases with age. The only treatment for OH is surgical intervention, and the approaches used vary greatly. Consequently, a well-defined consensus has not yet emerged. We assessed the efficiency and safety of the midline extraperitoneal approach for OH. Six patients with OH repaired using the midline extraperitoneal approach at KKR Sapporo Medical Center between April 2011 and January 2016 were included in the study. We retrospectively evaluated the patient characteristics, intraoperative findings, and the postoperative course. All patients were elderly women [median age, 90 (range, 79-92) years], with a median body mass index of 17.0 (range, 15.6-18.3) kg/m2 at presentation. All had symptoms associated with bowel obstruction: two patients presenting with leg pain had the Howship-Romberg sign. In two patients, bowel resection was required because of irreversible ischemic changes. Five patients had coexisting femoral and inguinal hernias that were repaired by bilateral mesh repair. One patient had aspiration pneumonia as a postoperative complication. All patients were discharged alive, without infection or recurrence. OH can be efficiently and safely repaired using the midline extraperitoneal approach. This approach establishes the diagnosis of OH, avoids injuring obturator vessels, gives improved exposure of the obturator canal, enables identification and simultaneous repair of other pelvic hernias, and facilitates bowel resection. This approach reduces the risk of mesh infection in patients undergoing bowel resection.
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Kawanaka H, Hiroshige S, Kubo N, Hirashita T, Masuda T, Kaisyakuji Y, Tajiri H, Egashira A, Matsumoto T, Yano T. Therapeutic Strategy for Incarcerated Obturator Hernia Using Preoperative Manual Reduction and Laparoscopic Repair. J Am Coll Surg 2018. [PMID: 29522816 DOI: 10.1016/j.jamcollsurg.2018.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Obturator hernia (OH) is a rare but serious disease associated with high morbidity and mortality due to advanced patient age and comorbidities. This study evaluated the feasibility of a laparoscopic approach to OH. STUDY DESIGN We retrospectively reviewed the records of 32 patients (median age 84 years; 31 women) with OH treated between 2003 and 2016. RESULTS Five patients with incidental OH underwent total extraperitoneal (TEP) repair. Of 27 patients with incarcerated OH, 18 patients underwent laparotomy, 13 of which required bowel resection, and the remaining 9 patients underwent preoperative ultrasound-guided manual OH reduction. Of 6 patients with successful OH release, 3 and 2 patients underwent TEP and transabdominal preperitoneal repair, respectively, and 1 patient declined the operation. Three patients with failure underwent laparoscopic exploration and conversion to open operation for bowel resection. Comparing the open and laparoscopic groups, the median operation times were 67.5 minutes vs 124 minutes, respectively (p = 0.004); median postoperative stay was 19 vs 11 days, respectively (p = 0.028); and Clavien-Dindo grade II or higher complications tended to be lower (28% vs 8%, respectively; p = 0.359). Even in patients without bowel resection, the median postoperative stay was significantly shorter in the laparoscopic group compared with the open group (7.5 vs 15 days, respectively; p = 0.032). During a mean follow-up of 24.5 months, the 3-year recurrence rate for OH was 25% for non-mesh repair and 0% for mesh repair (p = 0.335). Three- and 5-year cumulative survival rates were 83% and 71%, respectively. CONCLUSIONS Laparoscopic operations after ultrasound-guided manual reduction can be an alternative to emergent laparotomy in select OH patients.
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Affiliation(s)
- Hirofumi Kawanaka
- Clinical Research Institute and Department of Surgery, National Hospital Organization, Beppu Medical Center, Beppu, Japan.
| | - Shoji Hiroshige
- Clinical Research Institute and Department of Surgery, National Hospital Organization, Beppu Medical Center, Beppu, Japan
| | - Nobuhide Kubo
- Clinical Research Institute and Department of Surgery, National Hospital Organization, Beppu Medical Center, Beppu, Japan
| | - Teijiro Hirashita
- Clinical Research Institute and Department of Surgery, National Hospital Organization, Beppu Medical Center, Beppu, Japan
| | - Takeshi Masuda
- Clinical Research Institute and Department of Surgery, National Hospital Organization, Beppu Medical Center, Beppu, Japan
| | - Yushi Kaisyakuji
- Clinical Research Institute and Department of Surgery, National Hospital Organization, Beppu Medical Center, Beppu, Japan
| | - Hirotada Tajiri
- Clinical Research Institute and Department of Surgery, National Hospital Organization, Beppu Medical Center, Beppu, Japan
| | - Akinori Egashira
- Clinical Research Institute and Department of Surgery, National Hospital Organization, Beppu Medical Center, Beppu, Japan
| | - Toshifumi Matsumoto
- Clinical Research Institute and Department of Surgery, National Hospital Organization, Beppu Medical Center, Beppu, Japan
| | - Tokujiro Yano
- Clinical Research Institute and Department of Surgery, National Hospital Organization, Beppu Medical Center, Beppu, Japan
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Chen D, Fei Z, Wang X. Bowel obstruction secondary to incarcerated obturator hernia. Asian J Surg 2017; 40:193-196. [DOI: 10.1016/j.asjsur.2015.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/16/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022] Open
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Darwish S, Bell DJ. A rare presentation of small bowel obstruction. BJR Case Rep 2017; 3:20150310. [PMID: 30363295 PMCID: PMC6159293 DOI: 10.1259/bjrcr.20150310] [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: 08/12/2015] [Accepted: 06/17/2016] [Indexed: 11/20/2022] Open
Abstract
A 92-year-old, 41 kg female presented with a 4-day history of abdominal distension, intermittent lower abdominal pain, nausea, vomiting and lack of bowel opening. Contrast-enhanced CT scan of the abdomen and pelvis showed multiple dilated small bowel loops, secondary to incarceration of the ileum in an obturator hernia (OH) on the right. The patient underwent an emergency laparotomy with reduction of the OH. The small bowel was viable and no resection was required. OH is a rare but significant cause of small bowel obstruction, with a high mortality rate. Of all the imaging modalities reviewed, CT scan is highly effective in reducing diagnostic delay, and ultimately can reduce morbidity and mortality rates of patients presenting with an incarcerated OH.
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Yonekura S, Kodama M, Murano S, Kishi H, Toyoda A. Richter's Type of Incarcerated Obturator Hernia that Presented with a Deep Femoral Abscess: An Autopsy Case Report. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:830-833. [PMID: 27818487 PMCID: PMC5102243 DOI: 10.12659/ajcr.899791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 89 Final Diagnosis: Obturator hernia Symptoms: Coxalgia • femoral abscess • gait disorder Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Satoru Yonekura
- Department of Endocrinology, Tochigi Medical Center Shimotsuga, Tochigi City, Tochigi, Japan
| | - Masaaki Kodama
- Department of Surgery, Tochigi Medical Center Shimotsuga, Tochigi City, Tochigi, Japan
| | - Shunichi Murano
- Department of Endocrinology, Tochigi Medical Center Shimotsuga, Tochigi City, Tochigi, Japan
| | - Hirohisa Kishi
- Department of Surgical Pathology, Douai Kinen Hospital, Tokyo, Japan
| | - Akihiro Toyoda
- Department of Surgical Pathology, JA Kouseiren Kamitsuga General Hospital, Kanuma, Tochigi, Japan
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Light D, Razi K, Horgan L. Computed tomography in the investigation and management of obturator hernia. Scott Med J 2016; 61:103-105. [PMID: 27506814 DOI: 10.1177/0036933016638974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Obturator hernias are a rare groin hernia. They are most commonly found incidentally during laparoscopic inguinal hernia repair. We investigated our experience with obturator hernias in the elective and emergency setting. METHODS Cases of obturator hernia were identified from a hospital database and reviewed retrospectively over the last 10 years. There were no exclusions. There were a number of surgeons involved with an interest in groin hernia surgery. RESULTS Twenty-one patients were included. The mean age was 66 years old. Eleven were male. There were four emergency presentations. One emergency case presented with small bowel obstruction, while the other three cases presented with groin pain. Two patients had a preoperative computed tomography, which showed an obturator hernia confirmed at surgery. The patient with small bowel obstruction had an open bowel resection alone with no hernia repair. They were discharged with no complications or recurrence on follow-up. The other three cases had a mesh repair (one laparoscopic, one laparotomy, one pre-peritoneal). One patient who underwent a laparotomy died of a post-operative pneumonia. The others were discharged uneventfully. In the elective group of 17 patients, 8 patients were taken for an elective laparoscopic inguinal hernia repair but found to actually have an obturator hernia alone. An obturator hernia was found incidentally with an inguinal hernia in three patients. Five patients were expected to have an obturator hernia on clinical examination alone. At surgery, an obturator hernia was found in three cases. In the other two cases, no hernia was found. One patient had a pre-operative computed tomography, which showed an obturator hernia confirmed at surgery. CONCLUSIONS Computed tomography would be recommended in cases of diagnostic uncertainty. It may avoid unnecessary surgery in the elective setting and allow a focused procedure in the emergency setting. Laparoscopic repair is feasible in the emergency and elective setting with excellent results.
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Affiliation(s)
- Duncan Light
- Specialist Trainee General Surgery, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kasra Razi
- Core Trainee General Surgery, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Liam Horgan
- Consultant General Surgeon, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
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Liu J, Zhu Y, Shen Y, Liu S, Wang M, Zhao X, Nie Y, Chen J. The feasibility of laparoscopic management of incarcerated obturator hernia. Surg Endosc 2016; 31:656-660. [PMID: 27287915 DOI: 10.1007/s00464-016-5016-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/01/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obturator hernia (OH), a rare cause of acute small bowel obstruction, requires immediate surgical intervention to prevent serious complications and mortality. We assessed the safety and efficacy of laparoscopic surgery in patients with incarcerated OH presenting with acute abdomen in an emergency setting. METHODS Data pertaining to patients diagnosed with incarcerated OH between 2011 and April 2015 at our hospital were reviewed. Patients' characteristics, operation details and postoperative outcomes were retrospectively analyzed. RESULTS All ten patients diagnosed with incarcerated obturator hernia during the reference period were females (average age 72.1 ± 11.8 years; average weight 44.1 ± 6.9 kg; average body mass index 17.8 ± 2.1 kg/m2; average operating time 63 ± 15 min; average hospital stay 6.2 ± 6.6 days). Twelve occult hernias, including six contralateral OHs, two ipsilateral femoral hernias and two bilateral femoral hernias were detected in six patients (60 %), which were simultaneously repaired after laparoscopic exploration. Nine patients (90 %) were successfully treated with synthetic mesh by laparoscopic technique. Only one case required intraoperative conversion to open surgery due to strangulated intestine with perforation. Wound infection was reported in one patient who had undergone bowel resection, but with an eventual complete recovery. Postoperative period was uneventful in the other nine patients. No recurrence or complications were reported on follow-up (mean duration of follow-up: 6-54 months). CONCLUSION In this study, laparoscopic technique was associated with a reduced duration of hospital stay and fewer complications. In addition to being a safe and minimally invasive strategy, it allowed for simultaneous diagnosis and treatment of occult hernias during the same procedure. The approach may be a better option for the treatment of incarcerated OH and occult hernias in selected patients.
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Affiliation(s)
- Jing Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China
| | - Yilin Zhu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China
| | - Yingmo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China
| | - Sujun Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China
| | - Minggang Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China
| | - Xuefei Zhao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China
| | - Yusheng Nie
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China.
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[Strangulated obturator hernia simulating femoral hernia: A diagnostic challenge]. Presse Med 2016; 45:372-4. [PMID: 26857081 DOI: 10.1016/j.lpm.2015.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/08/2015] [Accepted: 10/14/2015] [Indexed: 11/24/2022] Open
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Kao SY, Lee TC, Weng ZC, Chen TH, Tsai PJ. Treatment of obturator hernia in a patient undergoing peritoneal dialysis. Perit Dial Int 2015; 34:803-5. [PMID: 25520487 DOI: 10.3747/pdi.2013.00116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Shih-Yi Kao
- Ten-Chan General Hospital Zhongli Taoyuan, Taiwan, R.O.C. Department of Rehabilitation & Health Center Su-Ao & Yuan Shan Branch of Taipei Veterans General Hospital, Taiwan, R.O.C. Division of Cardiovascular Surgery Department of Surgery, Taipei Medical University Hospital Taipei, Taiwan, R.O.C. Department of Surgery School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C. Department of Surgery Veterans General Hospital, National Yang Ming University School of Medicine, Taipei, Taiwan, R.O.C. Institute of Clinical Medicine National Yang-Ming University, Taipei, Taiwan, R.O.C. Department of Critical Care Medicine Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Ta-Chung Lee
- Ten-Chan General Hospital Zhongli Taoyuan, Taiwan, R.O.C. Department of Rehabilitation & Health Center Su-Ao & Yuan Shan Branch of Taipei Veterans General Hospital, Taiwan, R.O.C. Division of Cardiovascular Surgery Department of Surgery, Taipei Medical University Hospital Taipei, Taiwan, R.O.C. Department of Surgery School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C. Department of Surgery Veterans General Hospital, National Yang Ming University School of Medicine, Taipei, Taiwan, R.O.C. Institute of Clinical Medicine National Yang-Ming University, Taipei, Taiwan, R.O.C. Department of Critical Care Medicine Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Zen-Chung Weng
- Ten-Chan General Hospital Zhongli Taoyuan, Taiwan, R.O.C. Department of Rehabilitation & Health Center Su-Ao & Yuan Shan Branch of Taipei Veterans General Hospital, Taiwan, R.O.C. Division of Cardiovascular Surgery Department of Surgery, Taipei Medical University Hospital Taipei, Taiwan, R.O.C. Department of Surgery School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C. Department of Surgery Veterans General Hospital, National Yang Ming University School of Medicine, Taipei, Taiwan, R.O.C. Institute of Clinical Medicine National Yang-Ming University, Taipei, Taiwan, R.O.C. Department of Critical Care Medicine Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Tien-Hua Chen
- Ten-Chan General Hospital Zhongli Taoyuan, Taiwan, R.O.C. Department of Rehabilitation & Health Center Su-Ao & Yuan Shan Branch of Taipei Veterans General Hospital, Taiwan, R.O.C. Division of Cardiovascular Surgery Department of Surgery, Taipei Medical University Hospital Taipei, Taiwan, R.O.C. Department of Surgery School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C. Department of Surgery Veterans General Hospital, National Yang Ming University School of Medicine, Taipei, Taiwan, R.O.C. Institute of Clinical Medicine National Yang-Ming University, Taipei, Taiwan, R.O.C. Department of Critical Care Medicine Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Pei-Jiun Tsai
- Ten-Chan General Hospital Zhongli Taoyuan, Taiwan, R.O.C. Department of Rehabilitation & Health Center Su-Ao & Yuan Shan Branch of Taipei Veterans General Hospital, Taiwan, R.O.C. Division of Cardiovascular Surgery Department of Surgery, Taipei Medical University Hospital Taipei, Taiwan, R.O.C. Department of Surgery School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C. Department of Surgery Veterans General Hospital, National Yang Ming University School of Medicine, Taipei, Taiwan, R.O.C. Institute of Clinical Medicine National Yang-Ming University, Taipei, Taiwan, R.O.C. Department of Critical Care Medicine Veterans General Hospital, Taipei, Taiwan, R.O.C. Ten-Chan General Hospital Zhongli Taoyuan, Taiwan, R.O.C. Department of Rehabilitation & Health Center Su-Ao & Yuan Shan Branch of Taipei Veterans General Hospital, Taiwan, R.O.C. Division of Cardiovascular Surgery Department of Surgery, Taipei Medical University Hospital Taipei, Taiwan, R.O.C. Department of Surgery School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C. Department of Surgery Veterans General Hospital, National Yang Ming University School of Medicine, Taipei, Taiwan, R.O.C. Institute of Clinical Medicine National Yang-Ming University, Taipei, Taiwan, R.O.C. Department of Critical Care Medicine Veterans General Hospital, Taipei, Taiwan, R.O.C.
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Abstract
In this report, we highlighted the clinical manifestations of obturator hernia and focused on laparoscopic views. Given its rarity and vague symptoms, the early diagnosis of obturator hernia presents a challenge. Although delays in diagnosis cause high rates of morbidity and mortality, CT with multi-planar reformations provides an excellent means of preoperative diagnosis. Despite current progress of laparoscopic surgery, its indication is believed to be limited only in elective obturator hernia repairs because of technical difficulties associated with bowel strangulation followed by a resection anastomosis. However, in selected cases, laparoscopic techniques can provide a minimally invasive option for obturator hernia repairs. These laparoscopic views, together with CT imaging, allow a better understanding of spatial anatomy and abnormality surrounding an obturator hernia.
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36
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Seppälä TT, Tuuliranta M. Coexisting ipsilateral right femoral hernia and incarcerated obturator hernia. BMJ Case Rep 2015; 2015:bcr-2014-208361. [PMID: 25716157 DOI: 10.1136/bcr-2014-208361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Obturator hernia (OH) is an uncommon cause of bowel obstruction and described in elderly females in the literature. The treatment has traditionally been laparotomy because of an acute nature of the condition. However, because of old age and comorbidities that OH is associated with, general anaesthesia may need to be avoided. In the current case, a transinguinal preperitoneal approach and management are presented after delayed preoperative diagnosis of bowel obstruction caused by a coexisting right incarcerated OH and ipsilateral non-reducible femoral hernia. A 91-year-old woman had a 6-day history of nausea and vomiting. She was referred to surgery because of persisting vomiting, but without any abdominal pain. A CT scan showed a hernia in the right groin area but the diagnosis was delayed. The hernias were repaired using a preperitoneal transinguinal approach. Bowel resection was not needed. The obturator canal and the femoral ring were both covered by a Bard Polysoft patch.
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Affiliation(s)
- Toni T Seppälä
- Department of Gastroenterologic Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Mikko Tuuliranta
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
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37
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Kisaoglu A, Ozogul B, Yuce I, Bayramoglu A, Atamanalp SS. Obturator hernia, a rare cause of small bowel obstruction: case report. Eurasian J Med 2015; 46:224-6. [PMID: 25610330 DOI: 10.5152/eajm.2014.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 06/02/2014] [Indexed: 11/22/2022] Open
Abstract
Obturator hernia is a rare hernia in the world, diagnosed late since it has no specific symptoms and findings and generally occur in thin and old women with comorbidity.For this reason obturator hernia has high morbidity and mortality rates. In this study, we present an obturator hernia case that Howship-Romberg sign is positive and has typical appearance in computerized tomography. Laparotomy was performed on 89 years old female patient with body mass index 18.08 kg/m(2) by low middle line incision. Following the segmentectomy to the strangulated small bowel loop, obturator canal is repaired by retroperitoneal application. No complication occurred in the postoperative period. Obturator hernia should be taken into consideration in old and thin female patients with intestinal obstruction. Computerized tomography should be performed for early diagnosis of the obturator hernia.
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Affiliation(s)
- Abdullah Kisaoglu
- Department of General Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Bunyami Ozogul
- Department of General Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Ihsan Yuce
- Department of Radiology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Atif Bayramoglu
- Department of Emergency Medicine, Ataturk University Faculty of Medicine, Erzurum, Turkey
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38
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Affiliation(s)
- Yuki Tateno
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kensuke Adachi
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
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Tokushima M, Aihara H, Tago M, Tomonaga M, Sakanishi Y, Yoshioka T, Hyakutake M, Kyoraku I, Sugioka T, Yamashita SI. Obturator hernia: A diagnostic challenge. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:280-3. [PMID: 25006359 PMCID: PMC4085114 DOI: 10.12659/ajcr.890555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/14/2014] [Indexed: 11/29/2022]
Abstract
PATIENT Female, 90 FINAL DIAGNOSIS: Obturator hernia Symptoms: Epigastric pain • vomiting MEDICATION - Clinical Procedure: - Specialty: Gastroenterology and Hepatology. OBJECTIVE Challenging differential diagnosis. BACKGROUND Obturator hernia (OH) can be difficult to diagnose because it shows only nonspecific signs and symptoms. Although pain in a lower limb caused by compression of the obturator nerve by the hernia in the obturator canal (Howship-Romberg sign) is a characteristic sign, its presence is rather rare. CASE REPORT We herein describe the case of a 90-year-old woman with an OH that was difficult to diagnose because of her slight abdominal signs and symptoms on admission and subtle abdominal computed tomography (CT) findings. Although the CT images revealed the presence of an OH, this finding was overlooked because it contained only a part of the small intestine wall, which is called the Richter type. Fortunately, her condition improved dramatically with only conservative treatment. CONCLUSIONS Although early diagnosis is essential to reduce morbidity and mortality, OH can be a diagnostic challenge even with abdominal CT.
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Affiliation(s)
- Midori Tokushima
- Department of General Medicine, Saga University Hospital, Saga City, Japan
- The Community Center of General Medicine, Saga University Hospital, Saga City, Japan
| | - Hidetoshi Aihara
- Department of General Medicine, Saga University Hospital, Saga City, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga City, Japan
| | - Motosuke Tomonaga
- Department of General Medicine, Saga University Hospital, Saga City, Japan
| | - Yuta Sakanishi
- The Community Center of General Medicine, Saga University Hospital, Saga City, Japan
| | - Tsuneaki Yoshioka
- Department of General Medicine, Saga University Hospital, Saga City, Japan
| | - Masaki Hyakutake
- Department of General Medicine, Saga University Hospital, Saga City, Japan
| | - Itaru Kyoraku
- Department of General Medicine, Saga University Hospital, Saga City, Japan
| | - Takashi Sugioka
- The Community Center of General Medicine, Saga University Hospital, Saga City, Japan
| | - Shu-ichi Yamashita
- Department of General Medicine, Saga University Hospital, Saga City, Japan
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Togawa Y, Muronoi T, Kawaguchi H, Chiku T, Sano W, Hashiba T, Ueda A, Kaneoya K. Minimal incision transinguinal repair for incarcerated obturator hernia. Hernia 2014; 18:407-11. [PMID: 23644742 DOI: 10.1007/s10029-013-1095-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 04/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with incarcerated obturator hernia are usually elderly, frail, and physically inactive women with serious comorbidities. Although a laparotomy is standard surgical intervention for emergency incarcerated or strangulated obturator hernia, it is invasive particularly for these high-risk patients. The aim of this study is to show the feasibility of minimum open inguinal approach to reduce surgical risk for preoperatively diagnosed incarcerated obturator hernia. METHODS Between April 2008 and July 2012, 3 consecutive incarcerated obturator hernia patients at Kamitsuga General Hospital who were diagnosed preoperatively by computed tomography underwent the following procedure. First a 4 cm inguinal hernia incision and preperitoneal dissection through the opening of the deep inguinal ring are made. The obturator hernia can be easily found 2 cm dorsally from the Cooper's ligament extraperitoneally. A small incision is made at medial sharp edge of the hernia defect. The hernia sac and its content can then be reduced. If the incarcerated bowel is viable, a prosthetic mesh is placed as a patch. If the bowel is necrotic, the damaged bowel loop is withdrawn through the wound and easily reconstructed extra-abdominally. RESULTS All operations were successfully completed with this procedure. All patients recovered without incident. CONCLUSIONS Minimal incision transinguinal repair for diagnosed incarcerated obturator hernia is feasible and provides an improved option to more invasive procedures.
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Affiliation(s)
- Y Togawa
- Department of Surgery, Kamitsuga General Hospital, 1-1033 Shimota-cho, Kanuma, Tochigi, Japan,
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Tee CL, Evans T, Ratnayake S, Strekozov B. Small bowel obstruction secondary to bilateral obturator hernia: a rare occurrence. J Surg Case Rep 2014; 2014:rju009. [PMID: 24876374 PMCID: PMC4164190 DOI: 10.1093/jscr/rju009] [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: 11/13/2022] Open
Abstract
Obturator hernia (OH) is a rare type of pelvic hernia. It can cause significant morbidity and mortality, especially in the elderly age group. Delayed treatment is associated with high rates of strangulation (25-100%). We present an 88-year-old woman who presented with symptoms of bowel obstruction and right hip pain. Computed tomography (CT) abdomen revealed bilateral OHs and bowel obstruction secondary to the right OH. She was managed conservatively due to her age and co-morbidities and her bowel obstruction subsequently resolved. She was discharged, only to re-present 1 month later with similar complaints. A repeat CT scan revealed bilateral OHs and bowel obstruction due to the left OH. She underwent midline laparatomy and both OHs were reduced. The right OH was fixed with polypropylene mesh plug and the left OH was fixed with primary closure. The patient recovered and no recurrence was noted during follow-up.
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Affiliation(s)
- Chin Li Tee
- Department of Surgery, Caboolture Hospital, Caboolture, QLD, Australia
| | - Tobias Evans
- Department of Surgery, Caboolture Hospital, Caboolture, QLD, Australia
| | - Sujith Ratnayake
- Department of Surgery, Caboolture Hospital, Caboolture, QLD, Australia
| | - Boris Strekozov
- Department of Surgery, Caboolture Hospital, Caboolture, QLD, Australia
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Abstract
Hernia emergencies are commonly encountered by the acute care surgeon. Although the location and contents may vary, the basic principles are constant: address the life-threatening problem first, then perform the safest and most durable hernia repair possible. Mesh reinforcement provides the most durable long-term results. Underlay positioning is associated with the best outcomes. Components separation is a useful technique to achieve tension-free primary fascial reapproximation. The choice of mesh is dictated by the degree of contamination. Internal herniation is rare, and preoperative diagnosis remains difficult. In all hernia emergencies, morbidity is high, and postoperative wound complications should be anticipated.
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Affiliation(s)
- D Dante Yeh
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA.
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Chan KV, Chan CKO, Yau KW, Cheung MT. Surgical morbidity and mortality in obturator hernia: a 10-year retrospective risk factor evaluation. Hernia 2013; 18:387-92. [PMID: 24126886 DOI: 10.1007/s10029-013-1169-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 10/03/2013] [Indexed: 12/16/2022]
Abstract
UNLABELLED Obturator hernia is a rare condition occurring predominantly in elderly, thin, female patients and causes significant morbidity and mortality. Due to obscure presenting symptoms and signs, diagnosis and management are often delayed. While previous studies have attributed the high mortality to the delay in diagnosis, current literature remains controversial about this issue. The aim of this study was to identify peri-operative risk factors associated with mortality in patients with obturator hernia at our hospital. METHODS We retrospectively reviewed our series of 20 consecutive patients who underwent surgical repair of 21 obturator herniae and examined their clinical characteristics and post-operative outcomes. RESULTS Overall mortality rate was 47.6 %. Survivors did not differ from non-survivors in terms of basic demographics and operative parameters (operative time, blood loss and the need for intestinal resection). The use of computed tomography for pre-operative diagnosis was associated with reduced need for bowel resection, but did not result in shorter time to operation or improved morbidity and mortality. Our series demonstrated that early timing of surgery alone did not improve operative outcome. The absence of bowel motion and a high serum urea level at the time of operation were independent factors for mortality. CONCLUSIONS Obturator hernia remains a highly lethal surgical emergency. Adequate peri-operative resuscitation may be the key to further improvement in surgical outcomes.
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Affiliation(s)
- K V Chan
- Department of Surgery, Queen Elizabeth Hospital, Hong Kong, Hong Kong
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Karasaki T, Nakagawa T, Tanaka N. Sciatic hernia: is it really rare? Surg Today 2013; 44:1079-83. [DOI: 10.1007/s00595-013-0742-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/13/2013] [Indexed: 11/30/2022]
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Karasaki T, Nomura Y, Tanaka N. Long-term outcomes after obturator hernia repair: retrospective analysis of 80 operations at a single institution. Hernia 2013; 18:393-7. [DOI: 10.1007/s10029-013-1159-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 09/13/2013] [Indexed: 11/28/2022]
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Otowa Y, Kanemitsu K, Sumi Y, Nakamura T, Suzuki S, Kuroda D, Kakeji Y. Laparoscopic trans-peritoneal hernioplasty (TAPP) is useful for obturator hernias: report of a case. Surg Today 2013; 44:2187-90. [PMID: 23975587 DOI: 10.1007/s00595-013-0694-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
A 71-year-old female presented to our hospital due to pain from the right hip joint to the lower abdomen. The pain had suddenly appeared and spontaneously disappeared more than 10 times during the past 2 years. She had visited many hospitals, but remained undiagnosed. The patient underwent a computed tomography (CT) scan of the pelvis, and a soft tissue shadow was seen between the external obturator and pectineal muscles. She was diagnosed with a right obturator hernia and underwent elective repair by laparoscopic trans-peritoneal hernioplasty (TAPP). 1 year has passed since the surgery, without any recurrence of the abdominal pain. Obturator hernias are rare, and most cases are found as incarcerated hernias. It is rare to find an obturator hernia without intestinal obstruction, or with the recurrent pain as in our case. We herein report a case in which an obturator hernia was undiagnosed and intermittent pain was experienced for 2 years prior to TAPP, which appears to have successfully treated the hernia.
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Affiliation(s)
- Yasunori Otowa
- Division of Gastro-intestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kusunoki-chou 7-5-2, Chuo-ku, Kobe, 650-0017, Japan,
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Galketiya K, Sakrepatna S, Gananadha S. Obturator hernia-an uncommon cause of small bowel obstruction. J Gastrointest Surg 2013; 17:840-1. [PMID: 23132626 DOI: 10.1007/s11605-012-2061-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/12/2012] [Indexed: 01/31/2023]
Affiliation(s)
- Kamal Galketiya
- Department of Surgery, The Canberra Hospital, Australian National University Medical School, Canberra, ACT 2605, Australia.
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Karasaki T, Nakagawa T, Tanaka N. Obturator hernia: the relationship between anatomical classification and the Howship-Romberg sign. Hernia 2013; 18:413-6. [PMID: 23483264 DOI: 10.1007/s10029-013-1068-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 03/01/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND The obturator hernia sac may follow the anterior or posterior branch of the obturator nerve, and thus, it can be classified anatomically. The relationship between the symptoms and the anatomical classification of obturator hernia has not yet been clearly described in the literature. METHODS Multidetector-row computed tomography (MDCT) examinations of 35 consecutive cases of new-onset obturator hernia admitted from March 2005 to April 2012 were reviewed retrospectively. Obturator hernia was classified anatomically using MDCT. Patient characteristics and clinical presentations were compared among the anatomical classifications. RESULTS Fifteen cases were classified as type I (anterior branch type) and 20 cases as type II (posterior branch type). There were no significant differences regarding time from onset of symptoms to diagnosis, presence of small bowel obstruction, and need for bowel resection. The Howship-Romberg sign was seen in 6 cases (30 %) of type II and 10 cases (67 %) of type I (p = 0.044). CONCLUSIONS The Howship-Romberg sign was present significantly more often with the anterior than the posterior branch type of obturator hernia.
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Affiliation(s)
- T Karasaki
- Department of Surgery, Asahi General Hospital, I-1326, Asahi, Chiba, 289-2511, Japan,
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Leow JJ, How KY, Goh MH, Woon WWL, Low JK. Non-operative management of obturator hernia in an elderly female. Hernia 2013; 18:431-3. [PMID: 23299115 DOI: 10.1007/s10029-012-1036-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 12/27/2012] [Indexed: 11/30/2022]
Abstract
Obturator hernia is a rare surgical condition, with about 800 cases being reported in the literature. It can cause significant morbidity and mortality, especially in the elderly age group. Delayed treatment is associated with high rates of strangulation (25-100 %). The mainstay of management for obturator hernia has been surgical. Non-operative management can lead to significant morbidity and mortality, but may be an option in patients who decline surgery, as described in our case.
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Affiliation(s)
- J J Leow
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore,
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