Diagnosis and treatment of obturator hernia.

Abstract

Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, be cause delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our expe rience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n=7) or an inguinal approach (n=5). The hernial orifice was closed using the uterine fundus (n=6), a patch (n=5), and direct suture (n=1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in di agnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery.

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.…”

Interstinal Obstruction Due to Obturator Hernia {A Rarest Presentation}

“…The intra-abdominal approach through a low midline incision is most commonly used as it can establish the diagnosis, avoid the obturator vessels, expose the obturator ring, and facilitate bowel resection [8]. …”

Obturator Hernia : An Elusive Diagnosis

“…The intra-abdominal approach through a low midline incision is most commonly used as it can establish the diagnosis, avoid the obturator vessels, expose the obturator ring, and facilitate bowel resection if necessary [7]. Preperitoneal or laparoscopic approaches are favored if diagnosis is made preoperatively which is rarely the case [8].…”

“…Preperitoneal or laparoscopic approaches are favored if diagnosis is made preoperatively which is rarely the case [8]. Closure of the defect may be accomplished by multiple methods including plugging the canal with polypropylene (Marlex) mesh or teflon patch [7]. Occasionally, the local tissue is relatively immobile and requires a mesh closure, which was done in the above case.…”

“…Occasionally, the local tissue is relatively immobile and requires a mesh closure, which was done in the above case. Contralateral obturator canal defects are rarely repaired due to low recurrence rate and additional time required [7]. To conclude obturator hernia remains an unusual but important diagnosis in elderly thin patients with intestinal obstruction.…”