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At least 19 recordsLinked to original sources
PubMed2006

A rare cause of intestinal obstruction: incarcerated femoral hernia, strangulated obturator hernia.

Obturator hernia may occur bilaterally in association with another hernia, which is usually of the femoral type. We present a 77-year-old-woman who had abdominal pain with nausea and vomiting together with swelling of the right groin for 3 days. Incarcerated right femoral hernia and consequent mechanical small-bowel obstruction was diagnosed, and urgent operation was undertaken. As the incarcerated femoral hernia reduced spontaneously during the induction of anesthesia, a lower median incision was performed. During exploration, the real cause of mechanical intestinal obstruction was found to be a small intestinal loop strangulated in the left obturator hernia. Right femoral and left obturator hernia were repaired with preperitoneal polypropylene mesh. If there is enough time and general condition of the older patient is suitable, further diagnostic techniques for concomitant obturator hernias may be useful in patients who present with signs of incarcerated inguinal hernia and intestinal obstruction.

Aged↗
PubMed1988

Obturator hernia.

Obturator hernias are relatively rare. In the past 15 years at the Mayo Clinic, eight patients underwent nine operations for repair of 11 obturator hernias, which represented 0.073 per cent (11 of 15,098) of all hernias repaired at this institution. Elderly women with chronic disease were most frequently affected. Symptoms were usually intermittent; mechanical small intestinal obstruction was the most common presenting condition, followed by pain in the thigh or groin area. The Howship-Romberg sign was found in only two patients, and a correct preoperative diagnosis was made in only one patient. Midline abdominal incisions were made in all patients. Incarcerated ileum was the most frequently encountered organ in the hernia sac. Surprisingly, foci of endometriosis in the obturator defect accounted for symptoms in two patients with three obturator hernias. Right-sided obturator hernias outnumbered left, and bilateral obturator hernias were found synchronously in two instances and metachronously in one instance. The often debilitated state of the patients with obturator hernia and the frequent delay of diagnosis combined to produce significant operative morbidity and mortality rates.

Adult↗
PubMed2002

Diagnosis and treatment of obturator hernia.

Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n = 7) or an inguinal approach (n = 5). The hernial orifice was closed using the uterine fundus (n = 6), a patch (n = 5), and direct suture (n = 1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery.

Aged↗
PubMed1996

[Obturator hernia].

Obturator hernias are a rare type of hernias. Their incidence reported in large studies is 0.7% of all hernias. An obturator hernia may be the cause of otherwise unexplainable long-term dyspeptic complaints or subileous complaints and in the acute stage the cause of etiologically obscure obturation ileus. The difficulty of diagnosis is apparent also from the fact that a correct preoperative diagnosis is made only in 25-33%. Usually the diagnosis is established on operation of acute ileus. In these patients the mortality varies within a wide range of 12-70%. The authors recommend therefore to focus attention in chronic repeated dyspeptic or subileous conditions on predisposing factors in the case-history (female sex, 7th-8th decade, concurrent chronic disease, marked weight loss) and to examine also the only specific symptom of this hernia (Howship-Romberg sign).

Aged↗
PubMed1996

Laparoscopic repair of an incarcerated obturator hernia.

Obturator hernia is a rare cause of bowel obstruction. Occurring primarily in elderly women, it has a high incidence of incarceration and a high mortality rate. This report describes the successful laparoscopic reduction and repair of an incarcerated obturator hernia. Using open laparoscopy, an incarcerated obturator hernia was diagnosed intraoperatively. After laparoscopic reduction, a transabdominal preperitoneal repair was completed using polypropylene mesh. The patient recovered uneventfully with no recurrence at 6 months. Laparoscopic techniques have been successfully applied to diagnose, reduce, and repair an incarcerated obturator hernia.

Aged↗
PubMed1990

Bilateral and recurrent obturator hernia.

Obturator hernia is a rare condition which was first described in 1722 by de Ronsil. It occurs most commonly in elderly women who have lost weight and may strangulate in 25-100% of cases. Strangulated obturator hernia has a mortality as high as 10-50%, which is partly due to delay in diagnosis. A patient who developed three obturator hernias is described.

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PubMed2005

Laparoscopic transabdominal preperitoneal hernioplasty of bilateral obturator hernia.

Obturator hernia is relatively rare and tends to occur in elderly, emaciated women with chronic diseases. Clinical presentations are frequently delayed and so preoperative diagnosis is difficult. Treatment is always surgical. We present a case of a 75-year-old woman with bilateral obturator hernia diagnosed by the physical examination and abdominopelvic computed tomography (CT) scan; she had no signs of bowel strangulation. We used a laparoscopic approach for correction. A transabdominal preperitoneal hernioplasty was done using a prosthetic patch of polypropylene mesh. The patient recovered very well after surgery. We suggest that a laparoscopic approach may be used as treatment, when a nonstrangulated obturator hernia is diagnosed preoperatively.

Aged↗
PubMedDate not supplied

[Obturator hernia].

Obturator hernia, which is a rare cause of intestinal occlusion, generally presents non-specific signs and symptoms. Radiology may be sometimes useful for the diagnosis. Four cases of obturator hernia are described, and the possible surgical access routes are illustrated, emphasizing the use of prosthetic mesh.

Aged↗
PubMed2004

Forty-three cases of obturator hernia.

BACKGROUND: Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women. Because symptoms are nonspecific, the diagnosis is often delayed until laparotomy is performed form to treat bowel obstruction. METHODS: Forty-three patients with obturator hernia undergoing surgery at Tokyo Metropolitan Geriatric Hospital were divided retrospectively into two groups (group A = 23 patients from 1968 to 1986 before computed axial tomography [CAT] was developed; group B = 20 patients from 1987 to 1999 after CAT). Preoperative diagnosis, operative procedures, and postoperative course were reviewed and compared between the 2 groups. RESULTS: Preoperative diagnostic accuracy was significantly higher in group B at 80.0% (16 of 20 patients) than in group A at 43.5% (10 of 23 patients) (P = 0.0146). Rate of gut resection and mortality were significantly lower in group B at 25.0% (4 of 20) and 5.0% (1 of 20) than in group A at 52.2% (12 and 23) and 30.4% (7 of 23) (P = 0.0295 and P = 0.0385, respectively). CONCLUSIONS: The use of pelvic CAT in cases of suspected obturator hernia significantly enhances preoperative diagnostic accuracy and helps to decrease both intestinal resection rate and surgical mortality.

Aged↗
PubMed2006

[Atypical clinical picture of strangulated obturator hernia].

Strangulated obturator hernia is a very rare condition found almost always in elderly, debilitated multiparas usually with concomitant severe chronic illnesses. The authors presented a case of a young, 35-years-old woman of normal constitution, nullipara, without previous abdominal surgery. This unusual clinical picture despite the symptoms of intestinal obstruction caused difficulties in the correct preoperative diagnosis. It is the youngest case of patient with strangulated obturator hernia described in Polish medical literature.

Adult↗
PubMed1991

[Incarcerated obturator hernia].

Incarcerated obturator hernia is rare. One case is described which demonstrates many of the clinical features of the condition. Most affected are elderly women with chronic diseases, and the dominating symptoms are the same as for obstruction of the small bowel. The Howship-Romberg sign is said to be pathognomonic but is present in less than half of the cases. A correct preoperative diagnosis is rare. Resection of the small bowel is often necessary. The high mortality rate is due to the high age and often poor health of the patients, combined with late diagnosis.

Aged↗
PubMed2004

Endoscopic totally extraperitoneal repair for occult bilateral obturator hernias and multiple groin hernias.

INTRODUCTION: An obturator hernia is a rare hernia that is bilateral in about 6% of patients. Most patients present with chronic pelvic pain although a few patients may present with features of intestinal obstruction. Only about 10% of obturator hernias are diagnosed preoperatively. METHODS: A 65-year-old female patient with chronic obstructive pulmonary disease presented with bilateral groin swellings associated with local pain and heaviness. She also suffered from recurrent episodes of abdominal distension. She was diagnosed to have bilateral direct inguinal hernias and a left femoral hernia. At endoscopy under epidural anesthesia she was found to have a direct inguinal, an indirect inguinal, and a femoral hernia on the left side and an indirect inguinal hernia on the right side. Additionally, the endoscopic totally extraperitoneal approach to inguinal hernias identified hitherto undiagnosed bilateral obturator hernias. The hernias were reduced and polypropylene mesh was placed bilaterally covering the myopectineal orifice and pelvic floor bilaterally. RESULTS: The patient was discharged the next day and is symptom-free on followup at eight months. CONCLUSION: Endoscopic repair of groin hernias allows the surgeon not only to diagnose and treat unsuspected groin hernias but also allows identification, dissection, and repair of coincidental occult pelvic hernias like obturator hernias at the same time.

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PubMed1997

Preoperative diagnosis of strangulated obturator hernia using ultrasonography.

BACKGROUND: Obturator hernia is rarely recognized before surgical intervention, since it is relatively infrequent and its definitive diagnosis is difficult. To change this situation, we introduced ultrasound examination in 1993 for differential diagnosis of strangulated obturator hernia among patients with bowel obstruction of unknown cause. PATIENTS AND METHODS: Between 1993 and 1995, we encountered 15 patients with suspected obturator hernia based on the presence of bowel obstruction of unknown cause and so-called predisposing factors. These patients underwent ultrasound examinations. RESULTS: The 4 patients with bowel obstruction caused by strangulated obturator hernia were all correctly diagnosed preoperatively by ultrasonography and were successfully cured by surgery. The time required for diagnosis was shorter than reported previously (average 16.5 h). CONCLUSIONS: Ultrasonography is useful and reliable for the diagnosis of strangulated obturator hernia and can decrease the morbidity and mortality associated with delayed diagnosis.

Aged↗
PubMed1978

[Surgery of obturator hernia by closure of the obturator canal with the round ligament].

Almost 2/3rds of obturator hernias occur after 70 years. Favoured by changes in pelvic and spinal position, this hernia is uncommon in women and exceptional in men. Revealed by strangulation, it is in one third to one quarter of cases, unrecognised before operation, often due to failure to recognise the cause of crural neuralgia in a patient with acute intestinal obstruction. Even when the diagnosis is made, laparotomy is the best approach. It makes intestinal resection easier, this is necessary in 50% of cases, and above all, it is easier to cure the hernia for which the authors propose the use of the round ligament folded on itself and fixed to the borders of the hernial orifice. Delay in treatment explains the high mortality in this rare hernia.

Adnexa Uteri↗
PubMed1992

[Incarcerated obturator hernia causing bowel obstruction].

Obturator hernia is rare and is usually discovered by chance at operation or autopsy. In certain cases obturator hernia may cause sliding and strangulation of abdominal viscera inside the hernial sac, presenting clinically as bowel obstruction. An 83-year-old woman with signs of bowel obstruction was operated after 48 hours of conservative treatment and a small bowel loop was found strangulated inside the sac of an obturator hernia.

Aged↗
PubMed2001

Typical versus atypical presentation of obturator hernia.

Although it is a rare occurrence among all pelvic hernias diagnosed the obturator hernia continues to be a diagnostic challenge for surgeons today. These patients, who often have multiple concurrent medical problems, are subject to high morbidity and mortality rates resulting from late presentation and delayed surgical intervention. The vast majority of patients with obturator hernias are admitted with signs and symptoms of intestinal obstruction, namely anorexia, nausea, vomiting, constipation, and distension of 2 to 3 days' duration. In this paper, however, we highlight a small subset of obturator hernia patients who present without obstructive symptoms and do well after elective repair. The case reports that follow serve to compare and contrast two very different presentations of this surgical problem.

Adult↗
PubMed1996

[Strangulated obturator hernia. Preoperative diagnosis].

Strangled obturator hernia is uncommon; 600 cases have been reported in the literature since 1994. The diagnosis of strangled obturator hernia is rarely made preoperatively. We report a case of preoperative diagnosis which would suggest that laparoscopic surgery would be an interesting technique allowing both diagnosis and complete exploration of the abdominal cavity providing prognosis information for assessment of the lesion and treatment.

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