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

Abstract

Obturator hernia (OH) is a rare condition with high rates of morbidity and mortality. While diagnosis is difficult, surgery is the definitive treatment. Intestinal obstruction is the most common symptom upon admission. In addition, small-bowel obstruction is documented in more than half of OH patients. Advanced age, intestinal obstruction, bowel perforation, comorbid diseases, and clinical deterioration are risk factors for higher rates of mortality. The aim of the present report was to document clinical and surgical management of 3 female patients, each over 80 years of age, admitted to the emergency surgery department with intestinal obstruction and OH.

Prognostic Factors in Obturator Hernia

“…Multiple pregnancies, resulting in increased intra-abdominal pressure, cause weakening of the pelvic peritoneum and obturator membranes, which are prone to hernia development [4]. Malnutrition is a predisposing factor due to the decreased preperitoneal fat and lymphatic tissue over the obturator canal which increases the risk of herniation [5,6]. In addition to these risk factors, Mantoo et al [7] reported, Asians have been reported to have higher rates of OH while Western studies indicate a much lower incidence.…”

“…However, Igari et al [2] reported the incidence of OH was equal on both sides, Thanapaisan et al [1] reported left hernia are more common than right hernia, with a rate of 3:2, similar to our study. The hernia sac usually contains small bowel, especially ileum; although jejunum, colon, omentum, appendix, Meckel's diverticulum, ovary, fallopian tube, urinary bladder have all been reported in hernia sac [6].…”

“…It has been reported that the use of CT before surgery in patients with an obturator hernia reduces intestinal resection rates and mortality [8], Nasir et al [9] reported that preoperative CT is beneficial in the definitive and early diagnosis of the disease but has no effect on the postoperative survival rate and does not increase long-term survival. Due to delayed presentation, advanced age, and the presence of comorbidities, there is often a delay in the diagnosis and surgical intervention in patients with an obturator hernia [6]. Delay in the diagnosis may occur in these elderly patients due to their comorbidities and senescence with increased dementia [6].…”

“…Due to delayed presentation, advanced age, and the presence of comorbidities, there is often a delay in the diagnosis and surgical intervention in patients with an obturator hernia [6]. Delay in the diagnosis may occur in these elderly patients due to their comorbidities and senescence with increased dementia [6].…”

A Rare Cause of Small Bowel Obstruction: Incarcerated Obturator Hernia

“…Obturator hernia (OH) is a rare type of pelvic hernia occurring when the pelvic contents protrude through the obturator foramen (1)(2)(3)(4)(5)(6)(7)(8). OH, accounts for 0.07-1.4% of all abdominal hernias.…”