Obturator hernia: clinical analysis of 16 cases and algorithm for its diagnosis and treatment

Rodríguez-Hermosa, José Ignacio; Codina‐Cazador, A.; Maroto-Genover, Albert; Puig-Alcántara, J.; Sirvent-Calvera, J. M.; Garsot, Elisenda; Roig-García, Josep

doi:10.1007/s10029-007-0328-y

Cited by 94 publications

(121 citation statements)

References 21 publications

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“…[10] Better diagnostic performance with higher sensitivity and specificity rates are demonstrated by CT, as opposed to ultrasonography, direct abdominal x-ray radiographs, or magnetic resonance imaging. [11] CT is relatively non-invasive, a fast and reliable tool, with a preoperative diagnosis rate of 90%. [12] CT is thus defined as a gold standard, first-line imaging modality, particularly in cases of acute intestinal obstruction when supported with direct abdominal x-ray radiographs and subtle clinical presentation of OH.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Şenol

Bayam

Duman

et al. 2015

Ulus Travma Acil Cerrahi Derg

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Şenol

Bayam

Duman

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…In our case, although the diagnosis of obturator hernia was made preoperatively by CT, as a result of the continuing complaints of the patient for 10 days when admitted, resection of the small bowel has become unavoidable. Because of the delay in the diagnosis, intestinal ischemia and high incidence of perforation, post-operative mortality rate of these patients was reported as about 70% [8].…”

Section: Discussionmentioning

confidence: 99%

Obturator Hernia, a Rare Cause of Small Bowel Obstruction: Case Report

Kısaoğlu

Özoğul

Yuce

et al. 2014

EAJM

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Obturator hernia is a rare hernia in the world, diagnosed late since it has no specific symptoms and findings and generally occur in thin and old women with comorbidity.For this reason obturator hernia has high morbidity and mortality rates. In this study, we present an obturator hernia case that Howship-Romberg sign is positive and has typical appearance in computerized tomography. Laparotomy was performed on 89 years old female patient with body mass index 18.08 kg/m 2 by low middle line incision. Following the segmentectomy to the strangulated small bowel loop, obturator canal is repaired by retroperitoneal application. No complication occurred in the postoperative period. Obturator hernia should be taken into consideration in old and thin female patients with intestinal obstruction. Computerized tomography should be performed for early diagnosis of the obturator hernia.Key Words: Computerized tomography, Howship-Romberg sign, obturator hernia, small bowel obstruction ÖzetObturator herni tüm dünyada nadir görülen, spesifik semptom ve bulgularının olmaması nedeni ile tanısı geciken, daha çok komorbiditesi olan yaşlı ve zayıf kadınlarda ortaya çıkan ve bu nedenlerle morbiditesi ve mortalitesi yüksek olan bir hernidir. Bu çalışmada Howship-Romberg işareti pozitif olan ve bilgisayarlı tomografide tipik görüntünün olduğu obturator herni vakasını sunuyoruz. 89 yaşında, body mass indeksi 18.08 kg/m 2 olan kadın hastaya düşük orta hat insizyon ile laparotomi yapıldı. Strangüle olan ince barsak ansına segmentektomi yapıldıktan sonra obturator kanal retroperitoneal mesh tatbiki ile onarıldı. Postoperatif dönemde komplikasyon geliş-medi. İntestinal obstrüksiyonla gelen yaşlı ve zayıf kadın hastalarda obturator herni akılda tutulmalıdır. Erken tanı için bilgisayarlı tomografi çekilmelidir.Anahtar Kelimeler: Bilgisayarlı tomografi, Howship-Romberg işare-ti, obturator herni, ince barsak obstrüksiyonu

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“…Early diagnosis, appropriate imaging and prompt surgical intervention can reduce morbidity and mortality and improve prognosis. 3,4 This article has been peer reviewed.Competing interests: None declared. …”

mentioning

confidence: 99%

“…2 Preoperative diagnosis by computed tomography of the abdomen is important for detecting small-bowel gangrene and for planning surgical intervention. 3,4 Bedside ultrasonography of the abdomen in the emergency department can also be diagnostic. 5 Exploratory laparotomy is recommended when bowel strangulation or gangrene is suspected.…”

mentioning

confidence: 99%

Small-bowel obstruction secondary to obturator hernia

Wu¹,

Huang²,

Chen³

2010

Canadian Medical Association Journal

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A n 89-year-old woman presented with a three-day history of diffuse abdominal pain and vomiting. She also reported pain in the medial region of her right thigh, which was exacerbated by adduction. She had no history of abdominal surgery. On physical examination, she had a distended abdomen with decreased bowel sounds. No palpable inguinal mass or hernia was found. A radiograph of the abdomen showed dilated loops of small bowel and multiple airfluid levels suggestive of small-bowel obstruction ( Figure 1A). Computed tomography showed a bowel loop between the right obturator externus and pectineus muscles ( Figure 1B), consistent with a diagnosis of strangulated small-bowel obstruction secondary to an obturator hernia. In an emergency laparotomy, the affected bowel was resected and the hernia repaired.The patient's postoperative recovery was uneventful.An obturator hernia is a rare intra-abdominal hernia, accounting for 1% of all hernias and 1.6% of small-bowel obstructions. 1Obturator hernias are three times more common on the right side than on the left. Risk factors include age over 70 years, female sex (the female:male ratio is 6:1), multiparity, underweight, chronic constipation, chronic obstructive pulmonary disease and ascites.2 The diagnosis of obturator hernia is difficult because symptoms are nonspecific. In most patients, the condition is diagnosed during exploratory laparotomy for smallbowel obstruction. Pain along the ipsilateral thigh, exacerbated by adduction of the thigh (Howship-Romberg sign), is highly suggestive of an incarcerated obturator hernia and is caused by compression of the obturator nerve by the hernia. 2Preoperative diagnosis by computed tomography of the abdomen is important for detecting small-bowel gangrene and for planning surgical intervention.3,4 Bedside ultrasonography of the abdomen in the emergency department can also be diagnostic.5 Exploratory laparotomy is recommended when bowel strangulation or gangrene is suspected. Minimally invasive laparoscopic repair can be used for nonstrangulated, reducible obturator hernias. Early diagnosis, appropriate imaging and prompt surgical intervention can reduce morbidity and mortality and improve prognosis. 3,4 This article has been peer reviewed.Competing interests: None declared.

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Obturator hernia: clinical analysis of 16 cases and algorithm for its diagnosis and treatment

Abstract: Early diagnosis--we recommend CT in thin, elderly, multiparous women with intestinal obstruction--and early treatment can reduce complications and mortality.

Cited by 94 publications

References 21 publications

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

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

Obturator Hernia, a Rare Cause of Small Bowel Obstruction: Case Report

Small-bowel obstruction secondary to obturator hernia

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