Journal List > J Korean Surg Soc > v.77(3) > 1011009

TOOLS
Hwang, Chung, Jung, Heo, Ahn, and Chang: Successfully Treated Obturator Hernia in Spite of Delayed Operation
Case Report
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 77(3): 211-215.

Published online: 4 September 2009

DOI: https://doi.org/10.4174/jkss.2009.77.3.211

Successfully Treated Obturator Hernia in Spite of Delayed Operation

Ki-Tae Hwang, M.D., Jung Kee Chung, M.D., In Mok Jung, M.D., Seung Chul Heo, M.D., Young Joon Ahn, M.D., Mee Soo Chang, M.D.1

Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea.

1Department of Pathology, Seoul National University Boramae Hospital, Seoul, Korea.

Corresponding author (jkchung@brm.co.kr)

Received 31 December 2008       Accepted 3 March 2009

Copyright © 2009 The Korean Surgical Society

Abstract

Obturator hernia is a rare type of pelvic hernia and occurs most commonly in elderly and debilitated women. It is still a challenge for surgeons to diagnose precisely in early stages because of its nonspecific symptoms and consequently delayed diagnosis could lead to high morbidity and mortality. We experienced a 92-year old patient who was diagnosed as obturator hernia which was confirmed by computed tomography scan of the abdomen and pelvis. The operation was delayed due to the refusal of family members but eventually done after 12 days from initial diagnosis. After manual reduction of small bowel impacted into right obturator foramen, segmental resection of impacted small bowel and anastomosis was done. The hernial defect was closed by primary closure with Dexon suture material. After the operation, the patient was discharged without significant complications. We report here successful results of delayed operation for obturator hernia.

Keywords: Obturator hernia, Obturator foramen

Figures and Tables

Fig. 1
(A) A plain abdominal film in the supine position reveals multiple dilated loops of small intestine. (B) A film in the upright position shows multiple dilated loops with air-fluid levels.
jkss-77-211-g001
Fig. 2
Computed tomography scan of the abdomen and pelvis demonstrates a fluid-filled, low-density mass located between the right pectineus muscle and the external obturator muscles (arrow).
jkss-77-211-g002
Fig. 3
Operative field of the right obturator foramen region. (A) Incarcerated small bowel at right obturator foramen is observed. (B) The hernia sac in the right obturator canal is noted with tip of forceps. (C) After segmental resection and anastomosis of impacted small bowel, hernia defect is repaired by primary suture.
jkss-77-211-g003

References

1. Bjork KJ, Mucha P Jr, Cahill DR. Obturator hernia. Surg Gynecol Obstet. 1988. 167:217–222.
2. Kim JJ, Jung H, Oh SJ, Lee KH, Park SM, Kim YH, et al. Laparoscopic transabdominal preperitoneal hernioplasty of bilateral obturator hernia. Surg Laparosc Endosc Percutan Tech. 2005. 15:106–109.
3. Yip AW, AhChong AK, Lam KH. Obturator hernia: a continuing diagnostic challenge. Surgery. 1993. 113:266–269.
4. Haraguchi M, Matsuo S, Kanetaka K, Tokai H, Azuma T, Yamaguchi S, et al. Obturator hernia in an ageing society. Ann Acad Med Singapore. 2007. 36:413–415.
5. Chowbey PK, Bandyopadhyay SK, Khullar R, Soni V, Baijal M, Wadhwa A, et al. Endoscopic totally extraperitoneal repair for occult bilateral obturator hernias and multiple groin hernias. J Laparoendosc Adv Surg Tech A. 2004. 14:313–316.
6. Kim HA, Lee RA, Kim KH. Obturator hernia which was combined with inguinal hernia and hiatal hernia. J Korean Surg Soc. 2005. 68:168–171.
7. Lo CY, Lorentz TG, Lau PW. Obturator hernia presenting as small bowel obstruction. Am J Surg. 1994. 167:396–398.
8. Newsom BD, Kukora JS. Congenital and acquired internal hernias: unusual causes of small bowel obstruction. Am J Surg. 1986. 152:279–285.
9. Skandalakis LJ, Androulakis J, Colborn GL, Skandalakis JE. Obturator hernia. Embryology, anatomy, and surgical applications. Surg Clin North Am. 2000. 80:71–84.
10. Cali RL, Pitsch RM, Blatchford GJ, Thorson A, Christensen MA. Rare pelvic floor hernias. Report of a case and review of the literature. Dis Colon Rectum. 1992. 35:604–612.
11. Losanoff JE, Richman BW, Jones JW. Obturator hernia. J Am Coll Surg. 2002. 194:657–663.
12. Tchupetlowsky S, Losanoff J, Kjossev K. Bilateral obturator hernia: a new technique and a new prosthetic material for repair-case report and review of the literature. Surgery. 1995. 117:109–112.
13. Yokoyama Y, Yamaguchi A, Isogai M, Hori A, Kaneoka Y. Thirty-six cases of obturator hernia: does computed tomography contribute to postoperative outcome? World J Surg. 1999. 23:214–216.
14. Ijiri R, Kanamaru H, Yokoyama H, Shirakawa M, Hashimoto H, Yoshino G. Obturator hernia: the usefulness of computed tomography in diagnosis. Surgery. 1996. 119:137–140.
15. Gray SW, Skandalakis JE, Soria RE, Rowe JS Jr. Strangulated obturator hernia. Surgery. 1974. 75:20–27.
16. Rizk TA, Deshmukh N. Obturator hernia: a difficult diagnosis. South Med J. 1990. 83:709–712.
TOOLS
Similar articles