Elective plug repair of an incarcerated obturator hernia by the thigh approach after noninvasive manual reduction: Report of two cases

Tanaka, Naoki; Kikuchi, Jun; Ando, Toshinori

doi:10.1007/s00595-008-4025-y

Cited by 15 publications

(16 citation statements)

References 12 publications

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“…Although there was only one death among those patients, the number of patients with complications (29 of 33 patients) was large, and it was considered that elective surgery should be performed whenever possible. Various methods for noninvasive reduction including a method for reduction by flexure, external rotation and adduction of the diseased leg 6) and a method of ultrasonography-guided reduction 3,4,7) have been reported since the first successful case of reduction through the vagina reported by Funato et al in 1990 8) . As far as we know, there has been no report in Japan of intestinal damage after noninvasive reduction.…”

Section: Discussionmentioning

confidence: 99%

The Possibility of Elective Surgery in Obturator Hernia

Takahashi

Omori

Yoshifuku

et al. 2014

JJCS

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Abstract[Purpose] The usefulness of elective surgery after noninvasive manual reduction has been reported for cases of obturator hernia, but there is no consensus regarding indication of manual reduction. Therefore, we examined obturator hernia cases that we experienced in our hospital and evaluated the indication of manual reduction. [Materials and Methods] Thirty-three patients who underwent emergent surgery in the period from January 2003 to May 2013 were divided into a non bowel resection group (group A) and bowel resection group (group B).[Results] The average CRP level in group A was significantly lower than that in group B. The duration of symptoms in group A was significantly shorter than that in group B. The ratio of cases in which the contrast effect of the strangulated intestine on enhanced CT was maintained was higher in group A than in group B.[Conclusion] Noninvasive manual reduction and elective surgery should be considered in the case in which the contrast effect of the strangulated intestine has been maintained within 24 hours after onset and in which CRP level is less than 1.0mg/dl. Key words: obturator hernia, manual reduction, elective surgery IntroductionObturator hernias are mostly found in elderly and Received: December 4, 2013/ Accepted: March 31, 2014 Correspondence to: Yusuke Takahashi Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku Chuo-ku, Niigata, Niigata 950-1197, Japan underweight women, and emergent surgery is often performed in a poor state due to strangulation of the intestine and aspiration pneumonia after vomiting. Recently, the usefulness of elective surgery after noninvasive manual reduction has been reported for cases of obturator hernia, but there is no consensus regarding indication of manual reduction [1][2][3][4] . In the past 10 years, we have performed elective surgery after reduction of the incarcerated organ in two cases of obturator hernia, and we obtained good postoperative results. These two cases are presented here. We also reviewed cases of obturator hernia cases in which emergent surgery was performed in our hospital and evaluated the usefulness of elective surgery for obturator hernia. Case1Patient: 88-year-old woman. Chief complaint: right thigh pain. Past history: Hypertension. Present illness: She visited our hospital with the chief complaint of right thigh pain. Findings: Height ; 138cm, body weight ; 35kg, BMI ; 18.6. Tenderness in the right groin. Positive for Howship-Romberg sign． CT findings: The small intestine was incarcerated in the right obturator foramen on plain CT, and it was released spontaneously on additional contrastenhanced CT (Fig. 1 ). Treatment plan: She had bilateral inguinal hernias and we selected elective surgery. Operation: We performed hernioplasty bilaterally by Kugelʼs method.Her postoperative course was uneventful and she was discharged on the day after the operation. Tenderness in the right groin. CT findings: The small intestine was incarcerated in the right obturator foramen and intestinal obstr...

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Section: Discussionmentioning

confidence: 99%

The Possibility of Elective Surgery in Obturator Hernia

Takahashi

Omori

Yoshifuku

et al. 2014

JJCS

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“…Interrupted sutures lead to an acceptable recurrence rate of less than 10 per cent. 3,4 Altogether, increased alertness for an obturator hernia should be emphasized in elderly female patients presenting with bowel obstruction. Definite and early diagnosis can be facilitated by combined abdominal and pelvic CT scan.…”

Section: Increased Mortality From Delayed Diagnosis and Treatment Of Obturator Hernia In Elderly Patientsmentioning

confidence: 99%

Increased Mortality from Delayed Diagnosis and Treatment of Obturator Hernia in Elderly Patients

Seewoo

Jin

Yang

et al. 2012

The American Surgeon™

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Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.In general, authors of case reports should use the Brief Report format.

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“…56 In cases of patients with an incarcerated obturator hernia and a history of previous groin hernia operations, elective manual reduction and subsequent plug repair via the thigh approach has been suggested. 59 Initially, the hernia is reduced manually under ultrasonographic guidance. 59 Subsequently, a longitudinal upper thigh incision along the lateral border of the adductor longus muscle is made, and the obturator neurovascular bundle is identified at the interface between the adductor longus and the pectineus muscles.…”

Section: Repair Of the Defectmentioning

confidence: 99%

“…59 Initially, the hernia is reduced manually under ultrasonographic guidance. 59 Subsequently, a longitudinal upper thigh incision along the lateral border of the adductor longus muscle is made, and the obturator neurovascular bundle is identified at the interface between the adductor longus and the pectineus muscles. The bundle is followed proximally, revealing the obturator canal, and a plug is inserted and fixed in the canal without using sutures.…”

Section: Repair Of the Defectmentioning

confidence: 99%

Obturator Hernia Revisited: Surgical Anatomy, Embryology, Diagnosis, and Technique of Repair

Stamatiou

Skandalakis

Zoras

et al. 2011

The American Surgeon™

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Obturator hernia is the protrusion of intraperitoneal or extraperitoneal organs or tissues through the obturator canal. The first case was published by de Ronsil in 1724. Obturator hernia is more common in older malnourished women due to loss of supporting connective tissue and the wider female pelvis. The hernia sac usually contains small bowel, especially ileum. It may follow the anterior or posterior division of the obturator nerve. In most cases, obturator hernia presents with intestinal obstruction of unknown cause. It may present with obturator neuralgia, as a palpable mass or, in cases of bowel necrosis, as ecchymosis of the thigh. A correct diagnosis is made in 20 to 30 per cent of cases. CT scan is considered the gold standard for diagnosis, whereas ultrasonography, contrast studies, herniography and plain films are less specific. Surgery is the only treatment option for obturator hernia. Hesitancy to intervene surgically for chronically ill patients results in high mortality. Transabdominal approach is indicated in cases of complete bowel obstruction or suspected peritonitis. The extra-abdominal approach is used in preoperatively diagnosed cases and in absence of bowel strangulation. The laparoscopic approach is minimally invasive and effectively reduces morbidity. The defect is closed using sutures, tissue flaps, or prosthetic mesh.

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Elective plug repair of an incarcerated obturator hernia by the thigh approach after noninvasive manual reduction: Report of two cases

Cited by 15 publications

References 12 publications

The Possibility of Elective Surgery in Obturator Hernia

The Possibility of Elective Surgery in Obturator Hernia

Increased Mortality from Delayed Diagnosis and Treatment of Obturator Hernia in Elderly Patients

Obturator Hernia Revisited: Surgical Anatomy, Embryology, Diagnosis, and Technique of Repair

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