No abstract available.
Hernia, Obturator* ; Polycystic Kidney, Autosomal Dominant*

Aged ; Female ; Hernia, Obturator ; complications ; Humans ; Intestinal Obstruction ; diagnostic imaging ; etiology ; Tomography, X-Ray Computed ; Ultrasonography

Obturator hernias usually occur in elderly persons. We sometimes miss the correct diagnosis because of vague symptoms and signs in older patients at initial presentation. For good clinical outcomes, we should make the correct diagnosis earlier, especially in aged patients. Here we report cases of obturator hernia in two aged patients without specific medical or surgical histories. Two older women suffered obturator hernias, which were characterized by clinical and radiographic features. They did not have any specific surgical and medical histories. For further evaluation of abdominal symptoms and signs, we did an abdominopelvic computed tomography (CT) scan in the emergency department. The CT scan revealed findings compatible with an obturator hernia in the area of the obturator foramen. They were treated and discharged without complications. When obturator hernia is suspected in a patient with related symptoms and signs, early CT scans should be considered to detect obturator hernia.
Aged ; Early Diagnosis ; Emergencies ; Female ; Hernia, Obturator ; Humans ; Tomography, X-Ray Computed

PURPOSE: We performed this study to share experiences in the management of obturator hernia, which is a very rare disease among elderly women, because rarity of this disease will not approve an expert institute or surgeon and because the aging society, Korea, can increase the incidence. METHODS: Patient characteristics, clinical manifestations and treatment results were retrospectively collected from the 12 obturator hernia patients since 2000 in the three hospitals of the authors. Twenty-one obturator hernia cases reported in the Korean literatures were reviewed. In addition, we analyzed clinical features and treatment results of the total 33 patients, collectively. RESULTS: Most of the patients were elderly women except one young, poorly nourished, male patient with pulmonary tuberculosis. Their mean age was 79.6 years. Sixty-four percent (21/33) of the patients had preoperative morbidity. Symptoms from the compression of the obturator nerve, which is an important clue to the diagnosis, were observed in 67% (22/33). Interestingly, spontaneous or suspicious-spontaneous reductions were reported in 7 (21%) patients. Abdominal CT scan was the major tool for diagnosis. Abdominal approach alone could successfully manage most cases, though 84% (27/32) needed anastomosis of the bowel. Operative mortality was 2 of the 32 cases but morbidity was 44% of the 32 patients and the mean hospital period after operation was 21 days. CONCLUSION: Management of patients with obturator hernJd surgical management and proper peri-operative care as well as appropriate managing the families is essential for improved results.
Aged ; Aging ; Female ; Hernia, Obturator ; Humans ; Incidence ; Korea ; Male ; Obturator Nerve ; Rare Diseases ; Retrospective Studies ; Tuberculosis, Pulmonary

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.
Abdomen ; Aged ; Benzenesulfonates ; Delayed Diagnosis ; Disulfiram ; Female ; Hernia ; Hernia, Obturator ; Humans ; Pelvis ; Sutures

An obturator hernia is an exceptionally rare form of hernia. It occurs mostly in elderly, thin, multiparous, and emaciated women. Correct diagnosis and treatment is important because delayed treatment can lead to a higher mortality rate. Recently, we experienced two cases of mechanical small bowel obstruction due to incarcerated obturator hernia. One of these patients was an 83-year-old woman who was diagnosed with left incarcerated obturator hernia by computed tomography (CT). The patient's symptom disappeared abruptly. A recheck CT scan revealed self-reduction of the obturator hernia, and the patient refused operation. Two weeks later, the patient was presented again to the emergency clinic with incarcerated small bowel in the left obturator hernia, which was seen on CT. The other patient was a 79-year-old woman who had a 2-day history of abdominal pain. She was diagnosed with a right obturator hernia by CT. Both patients were treated without bowel resection.
Abdominal Pain ; Aged ; Aged, 80 and over ; Emergencies ; Female ; Hernia ; Hernia, Obturator ; Herniorrhaphy ; Humans

Obturator hernia is a rare variety of pelvic hernia. The diagnosis frequently is delayed and may be accompanied by dehydration, acute abdominal distress and small bowel strangulation. We report a case of totally extraperitoneal repair of obturator hernia with partial intestinal obstruction. An eighty-two-year old female with intermittent abdominal pain was diagnosed with obturator hernia with partial intestinal obstruction. We did total extraperitoneal laparoscopic repair of the obturator hernia with polypropylene mesh. Total extraperitoneal laparoscopic repair for obturator hernia is a safe and effective treatment.
Abdominal Pain ; Dehydration ; Female ; Hernia ; Hernia, Obturator ; Humans ; Intestinal Obstruction ; Polypropylenes

INTRODUCTIONObturator hernia is an important cause of small bowel obstruction and is associated with difficult diagnosis and high mortality.

MATERIALS AND METHODSWe reviewed 22 cases of intestinal obstruction due to obturator hernia that necessitated surgical intervention over the last 17 years and evaluated the changes in the number of patients based on the census data.

RESULTSAll cases were elderly females. The Howship-Romberg sign was present in 15 patients (68%). Computed tomography (CT) correctly diagnosed 13/15 (87%) of cases in which it was performed prospectively. The median time to surgery was 7.5+/-5.2 days for those patients with bowel resection, compared to 0.8+/-1.3 days for those without (P <0.05). The number of patients with obturator hernia has increased with an ageing society.

CONCLUSIONSThe rising incidence of obturator hernia is probably linked to an ageing society. CT of the pelvis was helpful in obtaining the correct diagnosis. The shorter the delay between admission and surgery, the lower the bowel resection rate. Laparotomy at an early stage is recommended in such patients as it leads to reduced morbidity and mortality.

Aged ; Aged, 80 and over ; Censuses ; Female ; Hernia, Obturator ; diagnosis ; epidemiology ; surgery ; Humans ; Japan ; epidemiology ; Medical Audit ; Outcome Assessment (Health Care) ; Population Dynamics ; Retrospective Studies ; Tomography, X-Ray Computed

Aged ; Aged, 80 and over ; Female ; Hernia, Obturator ; complications ; diagnostic imaging ; Humans ; Intestinal Obstruction ; etiology ; Tomography, Spiral Computed ; methods

An obturator hernia is a rare but important cause of small bowel obstruction, due to the difficulty of its diagnosis and the high mortality rate. Elderly, multiparous and debilitated women with comorbid illnesses are most often affected, and this hernia, coupled with a delay in the diagnosis and operative intervention, results in the high mortality rate, which represents both diagnostic and therapeutic challenges to the surgeon. Recently, we experienced two unusual obturator hernia cases, where incarceration had lead to a small bowel obstruction. One patient was an 82-year-old woman with a compression fracture of the lumbar spine, which presented with left inguinal pain and abdominal distension. The abdominal plain X-ray showed evidence of a small bowel obstruction. The hernia was diagnosed by a computed tomography (CT) scan and repaired using the lower midline transperitoneal approach. To prevent a recurrence, the hernial defect was enforced with a polypropylene plug and mesh. The other patient was a 92-year old woman with fracture of the neck of the left femur, which presented with defecation difficulty and abdominal distension. The abdominal plain X-ray showed multiple distended small bowel loops consistent with small bowel obstruction. A contrast-enhanced CT scan of the abdomen and pelvis showed a right obturator hernia with strangulation. We recommended an emergency operation, but the patient refused the operative procedure. With on going conservative management, the symptom was fortunately resolved. Herein, we report these findings with a brief review of the literature.
Abdomen ; Aged ; Aged, 80 and over ; Defecation ; Diagnosis ; Emergencies ; Female ; Femur ; Fractures, Compression ; Hernia ; Hernia, Obturator* ; Humans ; Mortality ; Neck ; Pelvis ; Polypropylenes ; Recurrence ; Spine ; Surgical Procedures, Operative ; Tomography, X-Ray Computed