Search

We present a case of a 79-year-old female with a history of pain at the right groin for 9 days. Computer tomography of the pelvis showed herniation of the appendix through the obturator canal with a huge abscess surrounding the right hip joint. Laparotomy was performed and histopathology confirmed a perforated necrotic tip of the herniated appendix. An obturator hernia is a rare hernia of the pelvic floor. It is most common in old, emaciated, multiparous women and can cause groin pain with extension to the medial aspect of the thigh. In case of incarceration of bowel, patients also present with obstruction. Isolated incarceration of the appendix, however, does not cause obstruction. The diagnosis of an obturator hernia is often delayed, due to a non-specific clinical presentation. CT scan may offer the clue to the correct diagnosis and should be performed in case of a possible obturator hernia.

To assess clinical, therapeutic and diagnostic findings of strangulated obturator hernias.Retrospective study of 17 patients (16 women, 1 man; average age: 81.7 years), all treated in the same service, for strangulated obturator hernia. The studied criteria were: clinical characteristics (general status, obstruction, sign of Romberg-Howship), morphologic exams, mean delay for surgical treatment, and occurrence of postoperative complications.The clinical examination revealed small bowel obstruction in 94% of the patients (n = 16) and incomplete obstruction in 1 patient; 23.5% of the patients presented a sign of Romberg-Howship. A major slimming was observed in 82% of the cases. A computed tomography, performed in 3 patients, showed the presence of air in the under-pubic channel. Preoperative diagnosis of obturator hernia was suspected in 23.5% of the cases. Surgical treatment was performed after a mean delay of 5.3 d. The mortality and morbidity rates were respectively 35 and 18%.Due to the low specificity of clinical examination, preoperative diagnosis of obturator hernia remains difficult. Computed tomography can be of great help for the diagnosis. Any therapeutic delay increasing mortality rate, surgery is mandatory in case of small bowel obstruction in order to make the diagnosis and the treatment of such rare pathology.

This paper is compound of diverse hernias of the antero-lateral and pelvic abdominal walls. Their unequal frequency is reflected by the unequal length of the related paragraphs. Their diverse anatomical sites are unified by the presence of a weak area defined by the absence of voluntary striated muscular fibers (those which are able to resist the intra-abdominal pressure waves). Their diagnosis, often difficult, ought to be better known and done prior to often deadly strangulation. Their treatment, at times discussed, can benefit from some progresses, like the use of prosthetic materials and, perhaps, calioscopic procedures; only an operation in due time can avoid the threatening strangulation of bowel.

We report two cases of obturator hernia diagnosed on CT scans. This examination contributes to both diagnosis and evaluation of prognosis allowing for improved treatment by reducing the number of intestinal resections. Abdominal CT is becoming the first line examination for all occlusion or subocclusion syndromes with no obvious diagnosis.

The repair of obturator hernia has been realized by closure of the obturator canal with a prosthetic material introduced via a combined inguino-crural incision and fixed on the Cooper ligament and on the anterior surface of the musculus adductor brevis.

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.