A Review of Obturator Hernia and a Proposed Algorithm for its Diagnosis and Treatment

Abstract

The aim of this article is to provide a review of six patients with the various stages of obturator hernia and a diagnostic and therapeutic strategy in suspected cases. Obturator hernia is relatively rare and is a diagnostic challenge. It is a significant cause of intestinal obstruction, especially in emaciated elderly women with chronic disease. A palpable groin mass is not common in these patients because the hernia mass is usually concealed beneath the pectineus muscle. The high mortality is directly related to the delayed recognition, with resultant ruptured gangrenous bowel, and to the high incidence of patients with concurrent medical illness. A total of six patients with obturator hernias were treated at this hospital between 1994 and 2004, and one of these patients was diagnosed and treated by elective laparoscopy. We reviewed these six cases and examined the clinical presentation, age, body weight, associated medical conditions, preoperative diagnosis, operative findings, complications, and outcome in this retrospective study. We concluded that we cannot shorten the time from onset of symptoms to admission, but what we can do is to make a rapid evaluation and surgical intervention to reduce the morbidity and mortality from obturator hernia. The approaches to different presentation of obturator hernia and diagnostic role of CT scan are also discussed.

Hernia obturatriz: una entidad con baja prevalencia pero alta mortalidad. Abordaje laparoscópico. A propósito de un caso

“…Con una tasa de mortalidad del 40 %, la hernia obturatriz es considerada la de mayor mortalidad 7,9,10 . Esto puede ser atribuido a varios factores: 1) la edad avanzada de los pacientes; 2) la alta tasa de estrangulación (25-100 %), dada la rigidez del orificio osteotendinoso, y 3) el retraso en el diagnóstico.…”

“…Se presenta habitualmente en mujeres ancianas, multíparas y desnutridas 5,6 . Su diagnóstico suele ser tardío, por lo que se considera una entidad con alta morbimortalidad, cercana al 40 % 7 . Se presenta un caso tratado en nuestro servicio, junto con una revisión de la bibliografía publicada sobre dicha patología.…”

Obturator Hernia : An Elusive Diagnosis

“…Obturator hernia was initially described by Arnaud de Ronsil in 1724 and was first successfully repaired in 1851 by Henry Obre [1]. It is an uncommon problem that occurs predominantly inelderly, debilitated women.…”

Challenging Management of Obturator Hernia: A Report of Three Cases And Literature Review

“…[5,6] Acute intestinal obstruction is the most significant clinical presentation, present in over 90% of OH patients. [2] Approximately half present with small-bowel strangulation.…”

“…[16] Several algorithms have been described for management of suspected OH to reduce morbidity and mortality. [6,11] Above all, clinicians should specify admission signs and symptoms of possible OH presentation with history and physical examination. The next step is to determine peritonitis findings and small-bowel obstruction with direct abdominal x-ray graphs and CT scan.…”