Clinical Presentation And Management Of Obturator Hernia

Purpose：Obturator hernia (OH) is a rare type of pelvic hernia. As thesymptoms are nonspecific and the physical findings are obscure, a correctdiagnosis is often delayed until laparotomy for bowel obstruction, despiteadvances in diagnostic modalities. The high postoperative mortality rate isoften attributed to the delay in diagnosis. This article aimed to review thediagnosis and management of OH patients at our hospital, by describing theclinical presentation, diagnostic modalities, and management.Methods: We reviewed ten patients who underwent surgery for an OHwithin a2-year period, We reviewed the medical records of these patients,examining their clinical presentation, age, body mass index (BMI),associated medical conditions, preoperative diagnosis, operative procedures,and postoperative out come.Results: There are11patients, most of the patients were elderly, thinwomen, with a mean age of77.64years (range:64–94years), a mean BMIof16kg/m2(range:13-21kg/m2) and a mean delivery of4.5children(range2–7). They revealed the signs of intestinal obstruction by a physicalexamination and an abdominal radiograph; CT scans were performed inmost of them except one who had operation immediatly. The presentingsymptoms included vomiting in60%of the patients and lower abdominal pain in50%. The HR sign was noted in9%of the patients. The OH was onthe right side in3patients and on the left side in the other8. OH wasdiagnosed preoperatively based on the CT findings in90%patients.Subsequently, they were sent to the operation room, The interval betweenthe estimated onset of symptoms and surgery ranged from1to15days(mean4.3days). The concomitant conditions included femoral hernia,chronic obstructive pulmonary disease, acute cholecystitis, myelofibrosis,angina pectoris, and atrial fibrillation. The operative findings showedcomplete or partial small bowel obstruction caused by small bowelinvolvement inside the hernia sac. Richter type obstruction was diagnosedin most of the patients and resection of part of the small bowel wasperformed in8patients. The defect of the hernia sac was simply closedwith interrupted or purse ring sutures, Postoperative complications wereencountered in4patients: pneumonia in one and wound infection in three.All patients recovered well and were discharged from hospital except2person died. The postoperative hospital stay ranged from1to20days(mean11.5days).Conclusions： Based on our experience, when an elderly, thin, andparous woman presents with vomiting, abdominal or thigh pain, andintestinal obstruction, the differential diagnosis should include OH. Earlydiagnosis and prompt initiation of treatment reduces the risk of surgicalcomplica-tions and increases the chance of survival.