Strangulated Obturator Hernia Research Articles

Obturator hernia: a persisting clinical diagnostic challenge – a case report

Introduction: The presentation of a strangulated obturator hernia is rare, with it accounting for less than 0.04% of all hernias. Delay in presentation and diagnosis results in complications like bowel ischemia, necrosis, perforation, and peritonitis, thereby increasing morbidity and mortality. Case presentation: The authors report the case of an 85-year-old multiparous woman who presented with a 3-day history of abdominal pain and vomiting. Upon examination, she exhibited hypotension, altered sensorium, and a distended abdomen with visible peristalsis. An abdominal pelvic computed tomography scan confirmed the diagnosis of ‘intestinal obstruction secondary to an incarcerated obturator hernia’. Subsequently, a lower midline laparotomy was performed, successfully reducing the bowel and repairing the hernial orifice. The patient was discharged on the fourth postoperative day, and there has been no hernia recurrence as of her 3-month follow-up. Discussion: The presentation of a strangulated obturator hernia can be elusive. During clinical examination, both the Howship–Romberg sign and the Hannington-Kiffs sign tests may be negative. Laparoscopic obturator hernia repair has been shown to reduce hospital stay and morbidity. A midline laparotomy has the advantage of easy manual reduction, minimizing bowel trauma, accurately accessing the bowel, and facilitating bowel resection. Conclusion: Obturator hernias constitute rare subtypes of abdominal hernias. They typically occur in older women, and patients often present with poor functional status and multiple comorbidities. The clinical diagnostic tests are uncertain, even in patients with a high index of suspicion. Timely diagnosis and appropriate surgical management are crucial for a favorable outcome.

Obstruction of Small Bowel due to Strangulated Obturator Hernia: Case Report

Introduction: Obturator hernia is one of the rare types of hernia and the important cause of small intestine obstruction. It mostly occurs in elderly people and women. This disease is challenging to diagnose and has a high mortality rate. Cese Presentation: In this study, two patients are introduced. The first patient was a 95-year-old woman who came with symptoms of gastrointestinal obstruction, nausea, bilious vomiting, as well as lack of gas and stool excretion. There was no suspicious pathological examination. The computed tomography (CT) scan was performed for the patient with the report of the left Obturator hernia. The second case is an 88-year-old woman with a history of neurological problems and symptoms of gastrointestinal obstruction, who had tenderness and rebound tenderness of the right lower quadrant of the abdomen during the examination. Since imaging findings were normal, the CT scan was performed for the patient, and the report was in favor of the right obturator hernia. Both patients underwent surgery with a midline incision of the abdomen. The small intestine was gangrenous at the hernia site and did not have proper peristalsis. Therefore, she underwent resection and anastomosis of the small intestine and repair of the obturator hernia. Conclusion: Obturator hernia is a rare but significant cause of intestinal obstruction, especially in emaciated elderly women. The diagnosis of this disease is challenging for doctors. One of the appropriate methods for diagnosing this disease is a CT scan of the abdomen and pelvis, and the only treatment method is surgery.

Emergency transabdominal preperitoneal (TAPP) repair of a strangulated obturator hernia: A literature review and video vignette.

Obturator hernia (OH), a rare and potentially life-threatening condition, presents diagnostic and therapeutic challenges. This review article comprehensively delves into the clinical features, diagnosis, and management of OH, with a particular emphasis on the pivotal role of computed tomography (CT) in timely and accurate diagnosis. Delays, particularly in contrast-enhanced CT, dramatically increase mortality due to potential bowel strangulation. To illustrate the challenges and complexities surrounding OH, we present a video vignette of a 74-year-old female patient who presented with symptoms suggestive of bowel obstruction (BO) secondary to a strangulated left-sided OH. This patient case complements the theoretical framework established in the review, serving as a practical example for healthcare professionals. Her presentation included abdominal pain, absence of flatus and bowel movements, and abdominal distension. Laboratory tests demonstrated a mildly elevated white blood cell count and C-reactive protein. CT imaging confirmed the diagnosis of a strangulated OH with an ischemic small bowel. An emergency laparoscopy was undertaken, and the hernia was repaired using the transabdominal preperitoneal approach. A portion of the ischemic small bowel was resected through a 5-cm extension of the umbilical port, and an anastomosis was performed using a modified Barcelona technique. The surgery was successfully completed without immediate or long-term complications. This case highlights the crucial role of timely CT diagnosis and minimally invasive surgical management in achieving improved outcomes in acute BO secondary to OH, particularly when facilitated by pre-operative CT planning.

Strangulated obturator hernia in a COVID-19 patient: a rare case presentation and the role of computed tomography in diagnosis

Strangulated obturator hernia in a COVID-19 patient: a rare case presentation and the role of computed tomography in diagnosis

Left incarcerated or strangulated obturator hernia: a case report

Obturator hernia is an extremely rare type of hernia with relatively high mortality and morbidity. Its early diagnosis is challenging since the signs and symptoms are non-specific. Obturator hernia is a rare but significant cause of intestinal obstruction especially in emaciated elderly women. Here a case of 93-year frail lady with incarcerated left sided obturator hernia with small bowel as content is presented, for which she underwent resection and ileoileal anastomosis and simple closure of the hernia defect.

Little old lady’s hernia: a case of strangulated obturator hernia in a 88-year-old woman

Obturator hernia is an extremely rare type of hernia and an uncommon cause of intestinal obstruction. Diagnosing it represents a challenge due to the lack of specific signs and symptoms. The delay in establishing the diagnosis is responsible for its high rate of mortality. The patients are usually older, emaciated, small women. We presented a case of a small, thin, 88-year-old woman that came to our emergency department with a four-day history of lower abdominal pain, more intense in the left iliac fossa associated with anorexia and constipation. The diagnosis of the left obturator hernia was made intra-operatively. The small bowel, inside the obturator foramen, was necrotic so we made an enterotomy with primary repair of the hernia defect. The patient had post-operative ileus and left inguinal seroma. She was discharged on day 15 post-op with a good recovery. This case report is meant to be an alert for the difficulty of the obturated hernia diagnosis.

OV13 LAPAROSCOPIC APPROACH IN EMERGENCY HERNIA SURGERY: MANAGEMENT OF ACUTE SMALL BOWEL OBSTRUCTION SECONDARY TO STRANGULATED OBTURATOR HERNIA

Abstract Aim Acute small bowel obstruction secondary to strangulated obturator hernia is a rare condition, with high rates of morbidity and mortality in the absence of prompt diagnosis and intervention. We aim to describe a case with the above presentation, managed using a minimally-invasive approach with positive outcomes. Material and Methods We describe a case of an 82-year-old female who presented with acute small bowel obstruction secondary to strangulated obturator hernia on cross-sectional imaging. Results The patient underwent emergency surgery using laparoscopic approach for repair of obturator hernia and assessment of obstructed small bowel. Our approach involved identification and reduction of small bowel loop. A transabdominal preperitoneal approach was made to obturator hernia and ischaemic sac was reduced followed by closure of defect with a plug of biologic mesh. A linear segment of ischaemic small bowel was oversewn. Total operative time was 90 minutes. Conclusions Minimally-invasive surgery is an important tool in the armamentarium of the acute care surgeon. A laparoscopic approach will reduce the insult of intervention in already physiologically deplete patients. This case demonstrates the feasibility of laparoscopy for small bowel obstruction secondary to strangulated obturator hernia in the acute setting, requiring advanced laparoscopic skill as demonstrated in this video.

248 Rectus flap for repair of Strangulated Obturator Hernia

Abstract Introduction Obturator hernia (OH) is a rare abdominal wall hernia which commonly presents as small bowel obstruction. Surgical options include suture repair or use of autologous tissue or a mesh repair when primary suture repair is not feasible. We describe a case involving the use of the rectus abdominus muscle to repair a large OH. Case report An 81-year-old female presented with three days of abdominal distension and vomiting. A computerised tomography scan confirmed small bowel obstruction due to an obstructed left OH. At laparotomy, a short segment of non-viable distal ileum was reduced from the sac and resected with a primary anastomosis. The obturator defect was not amenable for suture approximation and due to concerns of possible mesh infection, the ipsilateral rectus muscle belly was mobilised from the anterior sheath, routed extra-peritoneally to plug the defect without tension. The muscle was anchored with prolene sutures to the cooper’s ligament, pectineus muscle and the fascia overlying the inner surface of inferior pubic ramus. Four months post-operatively, she has made an excellent recovery with no concerns currently. Conclusions In OH with a large defect precluding primary suture repair, a range of options have been described (use of autogenous peritoneal fold, pectineus muscle, round ligament, ovary, uterine fundus, omental and mesh plugs, and biological mesh). We believe, to plug and cover the defect, rectus muscle flap is a viable option giving a tension free robust repair, especially in patients with gangrenous bowel and local contamination.

Strangulated obturator hernia with ischaemic and perforated small bowel.

Strangulated obturator hernia with ischaemic and perforated small bowel.

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

BackgroundObturator 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 presentation12 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.ConclusionAttempt 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.

A new technique for the incarcerated ileum reduction during laparoscopic obturator hernia repair: A case report and systemic review

Obturator hernia (OH) is a rare condition in all abdominal wall hernias, which usually presents with the symptoms of bowel obstruction caused by incarcerated intestinal segment, generally the ileum. We report a clinical case of an 81-year-old thin woman with 8-day history of nausea, vomiting, abdominal pain, and distension that aggravated for 1 day. A computed tomography scan showed an intestinal segment herniated into the obturator foramen in the left pelvic floor. A diagnosis of a left ileal, strangulated OH was made. A protective reduction management, air replacement method, was used to reduce the incarcerated ileum. Nonspecific symptoms of OH add difficulty in making diagnosis. Symptoms of bowel obstruction in patients with OH indicate incarceration. It is commonly seen in thin, elderly, multiparous women. Several ways for the reduction in patients with strangulated OH are described. Surgical approaches are the only choice for treatment. OH, a rare type in all hernias, is difficult to be diagnosed because of nonspecific symptoms. Air replacement method can reduce the incarcerated ileum successfully without unintentional injury.

A case report and a contemporary review of incarcerated and strangulated obturator hernia repair

A case report and a contemporary review of incarcerated and strangulated obturator hernia repair

A Case of Bilateral Strangulated Obturator Hernia Treated with Ultrasound Guided Reduction and Elective Laparoscopic Hernia Repair

A Case of Bilateral Strangulated Obturator Hernia Treated with Ultrasound Guided Reduction and Elective Laparoscopic Hernia Repair

Strangulated obturator hernia: a case report with literature review

Obturator hernia is rare. It occurs when part of the pelvic contents protrude through the obturator foramen. It is a diagnostic challenge in the emergency department since the signs and symptoms are non-specific. It often occurs in elderly, emaciated and chronically ill women. The clinical picture include intestinal obstruction with abdominal pain, nausea and vomiting. The treatment is only surgical. Delayed diagnosis of this condition usually leads to a high mortality rate. We report the case of an 83-year-old woman with a strangulated obturator hernia. The hernia was discovered early by computed tomography and was treated by emergency laparotomy. We emphasize on the rule of CT scan to establishing a prompt preoperative diagnosis of an obturator hernia, appropriate planning of surgical intervention and thus optimizing the outcome.

Strangulated Obturator Hernia: Difficult Diagnosis

Strangulated Obturator Hernia: Difficult Diagnosis

A rare case of strangulated obturator hernia presenting as subacute intestinal obstruction

An obturator hernia is a rare condition but is associated with the highest mortality of all abdominal wall hernias. They are notorious for their diagnostic difficulty and present a challenge to the surgeon. Preoperative diagnosis is often a rarity. They commonly present in elderly emaciated women, typically associated with chronic diseases. The most common symptom is strangulation combined with mechanical intestinal obstruction. Early surgical intervention is often delayed due to the absence of clinical and radiological clues. The following case report highlights these difficulties and reviews current literature on the management of such cases.

Perforated obturator Littré hernia in an elderly woman

Obturator hernia is an uncommon condition. It carries the highest mortality amongst abdominal wall hernias, usually presenting in elderly, multiparous and thin ladies. Meckel diverticulum is a rare cause of intestinal obstruction and its existence in an obturator hernia is extremely rare; our literature search revealed only two reported cases. We report the case of a 70-year-old woman who presented with signs and symptoms of intestinal obstruction and peritonitis. An exploratory laparotomy led to diagnosis of a strangulated obturator hernia. The sac contents included a Meckel diverticulum with a perforation at its base and a loop of the ileum. The ischemic ileal segment including the Meckel diverticulum was resected and a loop ileostomy was created.

İnce Barsak Tıkanıklığının Nadir Bir Sebebi: Obturator Herni

Obturator hernia is an uncommon disease and its diagnosis is challenging. It is more prevalent in thin, multiparous, elderly women. In this case report a 93-year-old woman patient with a right-sided strangulated obturator hernia was discussed with review of the relevant literature.

Minimal incision transinguinal repair for incarcerated obturator hernia

Patients with incarcerated obturator hernia are usually elderly, frail, and physically inactive women with serious comorbidities. Although a laparotomy is standard surgical intervention for emergency incarcerated or strangulated obturator hernia, it is invasive particularly for these high-risk patients. The aim of this study is to show the feasibility of minimum open inguinal approach to reduce surgical risk for preoperatively diagnosed incarcerated obturator hernia. Between April 2008 and July 2012, 3 consecutive incarcerated obturator hernia patients at Kamitsuga General Hospital who were diagnosed preoperatively by computed tomography underwent the following procedure. First a 4 cm inguinal hernia incision and preperitoneal dissection through the opening of the deep inguinal ring are made. The obturator hernia can be easily found 2 cm dorsally from the Cooper's ligament extraperitoneally. A small incision is made at medial sharp edge of the hernia defect. The hernia sac and its content can then be reduced. If the incarcerated bowel is viable, a prosthetic mesh is placed as a patch. If the bowel is necrotic, the damaged bowel loop is withdrawn through the wound and easily reconstructed extra-abdominally. All operations were successfully completed with this procedure. All patients recovered without incident. Minimal incision transinguinal repair for diagnosed incarcerated obturator hernia is feasible and provides an improved option to more invasive procedures.

Laparoscopic transabdominal pre-peritoneal obturator hernia repair: An operative technique

Introduction: Obturator hernia is a rare form of hernia that tends to occur in elderly emaciated women, and is typically associated with chronic diseases. Delay in clinical presentation and difficulty in diagnosis contribute significantly to the morbidity and mortality of this disease which can approach 13–40%. Treatment is always surgical and in most cases it is performed via an emergent laparotomy. Case Report: We report a case of a 59­year­old female who presented with right labial swelling and was diagnosed with an obturator hernia based on history and physical exam. An elective laparoscopic transabdominal pre­peritoneal (TAPP) approach was used to repair a non­ strangulated obturator hernia. We highlight the role of a laparoscopic repair and describe the technique used. Conclusion: A high index of suspicion for female patients with vaginal swelling or pain may prevent the eventual morbidity and mortality associated with stage 3 obturator hernia with incarceration. In this case report, we present a case of early detection of stage 1 obturator hernia which was successfully repaired using concepts of a TAPP approach. Outpatient laparoscopic repair of obturator hernia resulted in symptomatic relief at a three­ week follow­up. Laparoscopic approach may be useful for the repair of a non­strangulated obturator hernia, particularly if diagnosed in its early stages.