1
|
Miladinovic D, Buxey K. Laparoscopic repair of an obturator hernia; a case report of a contemporary surgical technique. Int J Surg Case Rep 2023; 105:108066. [PMID: 36989633 PMCID: PMC10074567 DOI: 10.1016/j.ijscr.2023.108066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Small bowel obstruction secondary to an obturator hernia is a rare presentation associated with high mortality. Prior to the development of laparoscopic surgery, a laparotomy would have been the management technique of choice for this rare presentation. CASE PRESENTATION An elderly female with a bowel obstruction secondary to an obturator hernia presented via the Emergency Department. A laparoscopic approach with the use of a haemostatic gauze plug was performed to repair the defect. CLINICAL DISCUSSION The evolution of surgical techniques, particularly with laparoscopy has resulted in overall benefits regarding patient outcomes. These benefits include lower post operative morbidity, shorter length of stay and decreased post operative pain. This report discusses a laparoscopic approach and the use of a gauze plug to manage an emergent small bowel obstruction secondary to an obturator hernia. CONCLUSION The use of a haemostatic gauze agent is an alternate and potentially advantageous approach for an obturator hernia repair in the emergency setting.
Collapse
Affiliation(s)
- Danjel Miladinovic
- Griffith Base Hospital, NSW, Australia; South-Eastern Sydney Network Prince of Wales Hospital, Prince of Wales Hospital, Avoca Street, Sydney, NSW, Australia; University of NSW, Sydney, Australia.
| | - Kenneth Buxey
- Griffith Base Hospital, NSW, Australia; Sandringham Hospital, Alfred Health, Australia
| |
Collapse
|
2
|
Kumar A, Mehdi K. Laparoscopic management of obturator hernia in the setting of intestinal obstruction: A report of two cases and review of literature. Med J Armed Forces India 2023; 79:113-116. [PMID: 36605339 PMCID: PMC9807685 DOI: 10.1016/j.mjafi.2020.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/28/2020] [Indexed: 02/07/2023] Open
Abstract
Owing to its rarity and non-specific clinical features, a diagnosis of obturator hernia is often delayed until the patient presents with intestinal obstruction. Often the diagnosis is made on a Computed Tomography (CT) scan or during exploratory laparotomy. While a laparoscopic approach is well described in an elective scenario, open surgery through a midline laparotomy has been the preferred approach for obturator hernia with intestinal obstruction. However, a few cases of obstructed obturator hernia have been reported that have been managed laparoscopically. We present our experience of two elderly patients who presented with intestinal obstruction. A CT scan helped clinch the diagnosis of obturator hernia as the cause and both were managed laparoscopically.
Collapse
Affiliation(s)
- Ameet Kumar
- Senior Advisor (Surgery) & GI Surgeon, 5 Air Force Hospital, Jorhat, India
| | - K.M. Mehdi
- Graded Specialist (Surgery), 5 Air Force Hospital, Jorhat, India
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Facing the unexpected: unusual causes of mechanical small bowel obstruction in adults. Clin J Gastroenterol 2021; 14:1287-1302. [PMID: 34076858 DOI: 10.1007/s12328-021-01450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
Mechanical small bowel obstruction in adults is a common emergency condition that typically requires hospitalisation and usually acute surgical intervention. The majority of the cases are due to adhesive obstruction or common abdominal wall hernias or relevant related past history. However, the surgeons might face unexpected challenges in this concept due to rare causes of this condition. This paper explores in depth the challenges encountered by the emergency general surgeons in the concept of management of rare causes of mechanical small bowel obstruction in adults through a systematic review and critical analysis of the available evidence, and summarises the essential intra-operative steps that are needed to be taken accordingly. In conclusion, the emergency surgeons should be familiar with the uncommon/rare causes of mechanical small bowel obstruction in adults to avoid serious complications. Successful outcomes are based on the combination of high index of clinical suspicion, familiarity with the standard anatomy and its variations, the use of the appropriate radiological investigations and surgical intervention in a timely manner.
Collapse
|
5
|
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.
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Herath M, Kanhere H. Loin to groin pain -A case report of an intermittent obturator hernia mimicking ureteric colic. Int J Surg Case Rep 2019; 66:356-359. [PMID: 31927400 PMCID: PMC6956747 DOI: 10.1016/j.ijscr.2019.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Obturator hernia is a rare condition and can cause significant diagnostic challenges due to a lack of reliable clinical examination signs. Presentations can have a variety of features and it is a diagnosis that needs to be considered - especially in elderly multiparous women. PRESENTATION OF CASE We present a 76-year-old female who has multiple presentations to the Emergency Department (ED) with transient episodes of severe loin to groin pain. Imaging Computer Tomography (CT) initially demonstrated a mild left hydronephrosis and she underwent an unremarkable ureteroscopy and stenting. Following stent removal she continued to have recurrent episodes of the pain. She presented to the ED with one such episode. A repeat CT scan was performed and this demonstrated an obturator hernia with partial small bowel obstruction. She underwent a laparoscopy by which time the hernia had reduced and her pain had settled. Laparoscopy revealed bilateral obturator herniae with the one on left larger than the right. Both were repaired laparoscopically and she made an uneventful recovery. DISCUSSION Obturator hernia is an uncommon condition and can have a varied presentation. Comprehensive review of literature demonstrates the difficulty in making accurate diagnosis. Open intervention was the initial gold standard of treatment but there is a growing body of evidence advocating for the use of laparoscopy in an emergency setting. CONCLUSION Early diagnostic imaging with CT while a patient is symptomatic can aid in making an accurate diagnosis. Laparoscopic repair can be safely used with good outcome in the context of an incarcerated obturator hernia.
Collapse
Affiliation(s)
- Matheesha Herath
- Port Augusta Hospital, 71 Hospital Road Port Augusta, South Australia, 5700, Australia; The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia.
| | - Harsh Kanhere
- Port Augusta Hospital, 71 Hospital Road Port Augusta, South Australia, 5700, Australia; The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia; The Queen Elizabeth Hospital, Woodville Road, Woodville, South Australia, Australia
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Ramkumar J, Lu D, Scott T. Laparoscopic Mesh Repair of Bilateral Obturator Hernias Post-Peritoneal Dialysis. Perit Dial Int 2019; 39:95-97. [PMID: 30692236 DOI: 10.3747/pdi.2018.00203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abdominal wall hernias are prevalent in patients undergoing peritoneal dialysis (PD). Obturator hernias, first described by Arnaud de Ronsil in 1724, are an uncommon type of hernia where intra-abdominal contents protrude through the obturator foramen. The following case highlights a rare presentation of bilateral obturator hernias with right femoral and inguinal hernia in an 82-year-old woman post-PD. This patient presented with 5 months of bilateral thigh pain and swelling and was found to only have a right-sided obturator hernia on computer tomography (CT) scan. Intraoperatively, bilateral obturator hernias were found along with right inguinal and femoral hernias, which were all repaired laparoscopically with polypropylene mesh. Postoperatively, the patient developed a self-limiting port site hematoma and resumed PD 1 month post-surgery. Due to the high morbidity and mortality from obturator hernias, prompt diagnosis and treatment are imperative. Compared with open hernia repair, laparoscopic hernia repairs are associated with quicker return to usual activities and less persisting pain and numbness. This case portrays that laparoscopic approach to bilateral obturator hernias can be considered in patients post-PD.
Collapse
Affiliation(s)
- Jonathan Ramkumar
- University of British Columbia, Division of General Surgery, Vancouver, BC, Canada
| | - Daphne Lu
- University of British Columbia, Division of General Surgery, Vancouver, BC, Canada
| | - Tracy Scott
- St. Paul's Hospital, Department of General Surgery, Vancouver, BC, Canada
| |
Collapse
|
10
|
Methodological overview of systematic reviews to establish the evidence base for emergency general surgery. Br J Surg 2017; 104:513-524. [PMID: 28295254 PMCID: PMC5363346 DOI: 10.1002/bjs.10476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/23/2016] [Accepted: 11/30/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The evidence for treatment decision-making in emergency general surgery has not been summarized previously. The aim of this overview was to review the quantity and quality of systematic review evidence for the most common emergency surgical conditions. METHODS Systematic reviews of the most common conditions requiring unplanned admission and treatment managed by general surgeons were eligible for inclusion. The Centre for Reviews and Dissemination databases were searched to April 2014. The number and type (randomized or non-randomized) of included studies and patients were extracted and summarized. The total number of unique studies was recorded for each condition. The nature of the interventions (surgical, non-surgical invasive or non-invasive) was documented. The quality of reviews was assessed using the AMSTAR checklist. RESULTS The 106 included reviews focused mainly on bowel conditions (42), appendicitis (40) and gallstone disease (17). Fifty-one (48·1 per cent) included RCTs alone, 79 (74·5 per cent) included at least one RCT and 25 (23·6 per cent) summarized non-randomized evidence alone. Reviews included 727 unique studies, of which 30·3 per cent were RCTs. Sixty-five reviews compared different types of surgical intervention and 27 summarized trials of surgical versus non-surgical interventions. Fifty-seven reviews (53·8 per cent) were rated as low risk of bias. CONCLUSION This overview of reviews highlights the need for more and better research in this field.
Collapse
|
11
|
Malik MU, Connelly TM, Hamid M, Pretorius F. Laparoscopic total extraperitoneal repair of preoperatively diagnosed bilateral obturator and incidental bilateral femoral herniae. BMJ Case Rep 2016; 2016:bcr-2016-214978. [PMID: 27113790 DOI: 10.1136/bcr-2016-214978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Obturator hernia (OH), a rare type of hernia, is associated with high morbidity and mortality. Diagnosis is often delayed as clinical symptoms are typically non-specific. OH is frequently associated with other occult inguinopelvic herniae. Early diagnosis is vital to decrease morbidity and mortality. We report the case of a 75-year-old woman who presented to the surgical outpatients' department with non-specific bilateral groin pain radiating to the thighs. CT of the pelvis demonstrated bilateral OH with no radiological evidence of bowel obstruction. Semiurgent elective laparoscopic total extraperitoneal mesh repair was performed. Intraoperative findings confirmed bilateral obturator herniae as well as incidental bilateral femoral herniae. This case highlights the need for a high index of suspicion for such concomitant hernias that, in the presence of OH, may only be identified intraoperatively.
Collapse
Affiliation(s)
| | - Tara M Connelly
- Department of Surgery, St Luke's Hospital Kilkenny, Kilkenny, Ireland
| | - Mustafa Hamid
- Department of Surgery, St Luke's Hospital Kilkenny, Kilkenny, Ireland
| | | |
Collapse
|
12
|
Laparoscopic reduction and repair for incarcerated obturator hernia: comparison with open surgery. Hernia 2014; 19:809-14. [PMID: 25504450 DOI: 10.1007/s10029-014-1328-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/26/2014] [Indexed: 12/29/2022]
Abstract
PURPOSE Transabdominal preperitoneal (TAPP) repair for obturator hernia (OH) is not well established. Therefore, we evaluated the efficacy of TAPP for OH repair compared with open surgery. METHODS We retrospectively analyzed patients who underwent surgery for OH at our hospital between 2006 and 2011. Since 2009, we have used TAPP repair for OH instead of open surgery. The clinical results of TAPP repair were compared with those of open surgery performed before 2008. RESULTS Six patients with OH were treated by TAPP repair; occult contralateral OH was found by laparoscopic exploration in three (50 %) patients and was simultaneously repaired. Bowel incarceration was reduced by water pressure through Nelaton catheter in all but one patient. Bowel resection was performed in two patients after the laparoscopic assessment. For incarcerated OH, five of six cases were repaired using synthetic mesh, and the remaining case was addressed with simple peritoneal closure. Before 2008, six patients with OH underwent open surgery. The background of patients was comparable in the TAPP group and the open surgery group. There were no deaths in either group, but one metachronous contralateral OH occurred in the open surgery group within a short time frame, whereas none occurred in the TAPP group. CONCLUSIONS TAPP repair, including the inspection of the viability of the incarcerated intestine and protective reduction and assessment of the entire groin area is an effective and minimally invasive strategy for OH patients.
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Abstract
Obturator hernia of the ureter is uncommon. Computed tomography of a 77-year-old woman with sudden-onset lower left abdominal pain and urinary symptoms showed an obturator hernia with ureteral entrapment. Obturator hernia is a diagnostic challenge because the hernial mass is very insidious. It should be suspected in emaciated, multiparous, elderly women presenting with unexplained pain in the groin, hip, thigh or knee. High levels of clinical suspicion of high-risk patients and recourse to investigation by computed tomography are important, as delay in diagnosis and treatment is associated with increased morbidity and mortality.
Collapse
Affiliation(s)
- Matteo Izzo
- Department of Surgery, Ospedale Beata Vergine, Mendrisio, Switzerland
| | - Luca Regusci
- Department of Surgery, Ospedale Beata Vergine, Mendrisio, Switzerland
| | - Fabrizio Fasolini
- Department of Surgery, Ospedale Beata Vergine, Mendrisio, Switzerland
| |
Collapse
|
15
|
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.
Collapse
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,
| | | | | | | | | | | | | |
Collapse
|
16
|
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.
Collapse
Affiliation(s)
- J J Leow
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore,
| | | | | | | | | |
Collapse
|