Ultrasound-guided non-invasive retraction for strangulated obturator hernia allows elective radical surgery: analysis of 12 cases

Abstract

Background Obturator hernia is a life-threatening condition, requiring emergency intervention due to strangulation, if non-invasive repair for strangulation cannot be complete. Change from emergency surgery to elective surgery using minimal non-invasive options can greatly contribute to perioperative safety and curability of the underlying disease. Case presentation 12 cases of strangulated obturator hernia from April 2013 to February 2020 with male:female patient ratio of 0:12. Reduction under ultrasound guidance was possible amongst 10 out of 12 cases. The average age was 85.3 years (74–97) and average BMI was 17.4 (15.0–20.1). Based on physical findings and CT examination, diagnosis of obturator hernia was made using echo guided non-invasive reduction. Prevention in the intestinal ischemia and perforation was observed in the treated cases. Upon request, elective radical surgery was performed in 7 of these patients after their condition improved and monitored other organs for any signs. Conclusion Attempt to improve the strangulation of obturator hernia under an echo-guided approach could enable elective and safe surgery and is believed to be a diagnostic treatment worth attempting.

Obturator hernia: A case report of intestinal obstruction with challenging diagnosis and non-standardized treatment

“…Finally, a very recent modality of treatment was used and consists in ultrasound –guided manual reduction for strangulated OH after excluding intestinal necrosis or perforation by the CT scan. This conservative procedure may avoid emergency surgery and allow a safe elective laparoscopic treatment after assessing a poor general condition [15] . We are not very convinced by the last method because we cannot be very sure and reassured by not only the total and complete reduction of the hernia content but also the absence of necrosis or perforation signs in CT scan, which can make this therapeutic method quite dangerous for the patient.…”

A Rare Cause of Medial Thigh Pain: Does Point-of-Care Ultrasound Scan Have a Role in the Diagnosis of Obturator Hernia in the Emergency Room?

“…While more research needs to be done to ascertain the sensitivity and specificity of POCUS in the diagnosis of obturator hernia, there has been documented use of POCUS in the diagnosis of obturator hernia [ 11 , 12 ].…”

Obturator hernia (the little old lady’s hernia) diagnosed via computed tomography: a case report

“…A noninvasive method, such as echo-guided reduction of the incarcerated hernia, can be chosen if it can be completed in 10–20 min or less, reducing morbidity and rendering only thigh bleeding as the major complication. If the echo-guided reduction takes more than 20 min, the patient ought to avoid it, and an emergency open laparotomy should be performed without hesitation 18 . Surgery is the only effective method of treatment for obturator hernia.…”