492 results on '"Hernia, Obturator"'
Search Results
2. Internal post-bariatric hernia due to hepatic adhesion: a case report
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Bruno Mirandola Bulisani, Murilo Rocha Rodrigues, Luiz Guilherme Lisboa Gomes, Milena Arruda de Oliveira Leite, Felipe Martin Bianco Rossi, Nathan Rostey, and Jaques Waisberg
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Bariatric surgery ,Gastric bypass ,Anastomosis, Roux-en-Y ,Hernia, obturator ,Incisional hernia ,Postoperative complications ,Medicine - Abstract
ABSTRACT Roux-en-Y gastric bypass, a procedure proven effective for treating morbid obesity and metabolic disorders, carries the risk of complications such as the formation of internal hernias. These hernias are often difficult to diagnose and can be potentially fatal because they can cause structural obstruction. Most internal hernias occur in the jejunojejunostomy mesentery space, followed by Petersen's space hernias, although herniation at other locations can also occur. Our case report presents an example of a rare internal hernia after laparoscopic Roux-en-Y gastric bypass. A 36-year-old woman presented with an uncommon internal hernia located between the liver and alimentary loop, resulting in the formation of a new space and consequently incarcerating the entire biliopancreatic loop. This type of internal hernia is rare and has not been reported in the literature, indicating that this is the first report of such a case. In this case, we realized that the diagnosis was challenging and imaging examinations could not help determine the etiology of the pain and obstruction. Therefore, videolaparoscopy revealed an uncommon hernia formed by firm adhesion between the hepatic segment III and the alimentary loop mesentery. Our case is an example of an internal hernia that was not detected with a normal computed tomography scan of the abdomen and pelvis. Only diagnostic laparoscopy revealed herniation, effectively preventing further complications for the patient. more...
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- 2023
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3. Internal post-bariatric hernia due to hepatic adhesion: a case report.
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Mirandola Bulisani, Bruno, Rocha Rodrigues, Murilo, Lisboa Gomes, Luiz Guilherme, de Oliveira Leite, Milena Arruda, Bianco Rossi, Felipe Martin, Rostey, Nathan, and Waisberg, Jaques
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HERNIA , *BARIATRIC surgery , *GASTRIC bypass , *COMPUTED tomography , *METABOLIC disorders , *LAPAROSCOPIC surgery , *SURGICAL complications , *MORBID obesity - Abstract
Roux-en-Y gastric bypass, a procedure proven effective for treating morbid obesity and metabolic disorders, carries the risk of complications such as the formation of internal hernias. These hernias are often difficult to diagnose and can be potentially fatal because they can cause structural obstruction. Most internal hernias occur in the jejunojejunostomy mesentery space, followed by Petersen's space hernias, although herniation at other locations can also occur. Our case report presents an example of a rare internal hernia after laparoscopic Roux-en-Y gastric bypass. A 36-year-old woman presented with an uncommon internal hernia located between the liver and alimentary loop, resulting in the formation of a new space and consequently incarcerating the entire biliopancreatic loop. This type of internal hernia is rare and has not been reported in the literature, indicating that this is the first report of such a case. In this case, we realized that the diagnosis was challenging and imaging examinations could not help determine the etiology of the pain and obstruction. Therefore, videolaparoscopy revealed an uncommon hernia formed by firm adhesion between the hepatic segment III and the alimentary loop mesentery. Our case is an example of an internal hernia that was not detected with a normal computed tomography scan of the abdomen and pelvis. Only diagnostic laparoscopy revealed herniation, effectively preventing further complications for the patient. [ABSTRACT FROM AUTHOR] more...
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- 2023
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4. Mechanical intestinal obstruction in underweight, elderly women due to an incarcerated obturator hernia
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Ke‐kang Sun and Yong‐you Wu
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Thinness ,Hernia, Obturator ,Humans ,Female ,Surgery ,General Medicine ,Herniorrhaphy ,Intestinal Obstruction ,Aged ,Retrospective Studies - Abstract
Obturator hernia is an infrequent pelvic hernia observed in elderly, emaciated and multiparous women. It often presents with nonspecific clinical symptoms, making it difficult to diagnose.We conducted a retrospective descriptive study on 11 patients admitted to our hospital for obturator hernia from 2009 to 2020.All the patients were diagnosed with intestinal obstruction due to incarcerated obturator hernia preoperatively. Eight patients underwent laparotomy with low midline incision. Laparoscopic approach was tried on the other three patients with two patients converting to open surgery because of inadequate visualization, and only one patient received laparoscopic repair. Of the 10 patients receiving laparotomy, seven cases received obturator hernia repair with a match and three cases were subjected to bowel resection (two cases intestinal necrosis and one case intestinal perforation). Simple peritoneal closure was performed on the three contaminated cases. One patient died of septic shock and multiple organ failure.The emergent computed tomography allow for early and precise diagnosis of incarcerated obturator hernia. Laparotomy with low midline incision is commonly used to manage obturator hernia in an emergency, whereas laproscopic approach may only apply to some selected cases. more...
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- 2022
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5. A decade review of emergency obturator hernia repairs
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Sarit Badiani, Christophe R. Berney, and Jason Diab
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medicine.medical_specialty ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Laparotomy ,medicine ,Humans ,Hernia ,Obturator hernia ,Herniorrhaphy ,Aged ,Retrospective Studies ,business.industry ,Mortality rate ,General surgery ,Australia ,Hernia, Obturator ,Retrospective cohort study ,General Medicine ,medicine.disease ,Bowel obstruction ,Acute abdomen ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Surgery ,medicine.symptom ,Presentation (obstetrics) ,business ,Intestinal Obstruction - Abstract
BACKGROUND Obturator hernia is a rare pelvic hernia associated with a high morbidity and mortality. It most commonly occurs in elderly, multiparous females with symptoms and signs of small bowel obstruction. We present an Australian hospital network experience on emergency presentations of obturator hernias highlighting differences between clinical profile and surgical management. METHODS A retrospective review of adult patients diagnosed with acute obturator hernia during a 10 year period (2010-2020) was conducted across 10 major Sydney hospitals in New South Wales, Australia. RESULTS Obturator hernia was diagnosed in 18 patients (mean 82.7 years, range: 60-96 years old), all confirmed on pre-operative computed tomography imaging. The most common presentations were elderly women demonstrating clinical features of a small bowel obstruction. The mean onset of symptoms from home to hospital admission was 49.4 h. Non-survivors had a significantly elevated urea level (15.6 vs. 7.8 mmol/L, p = 0.036) at presentation and a longer delay from onset of presenting symptoms to diagnosis (84.0 vs. 36.2 h, p = 0.028). Eleven patients underwent urgent laparotomy and six laparoscopic repairs. The mean operative time was 101.0 min. The average hospital length of stay was 16.2 days with a mortality rate of 27.8%. CONCLUSION Timely diagnosis and operative intervention for obturator hernia is the cornerstone of management. more...
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- 2021
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6. Obturator hernia: a case report
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Madiha Aziz, Jay N. Collins, and C. Kendall Major
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medicine.medical_specialty ,Hernia ,Signs and symptoms ,Medial compartment of thigh ,Abdominal wall ,03 medical and health sciences ,0302 clinical medicine ,Laparoscopic ,Surgical oncology ,Intestine, Small ,Case report ,medicine ,Humans ,030212 general & internal medicine ,Obturator hernia ,General surgery ,Aged, 80 and over ,Small bowel resection ,business.industry ,Abdominal Wall ,Hernia, Obturator ,General Medicine ,medicine.disease ,digestive system diseases ,Surgery ,Bowel obstruction ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Medicine ,Female ,Laparoscopy ,business ,Intestinal Obstruction - Abstract
Background Obturator hernia is rare and accounts for less than 1% of all abdominal wall hernias. It represents a diagnostic challenge due to its nonspecific signs and symptoms. Case presentation We present a case of an 89-year-old caucasian female with a 12-hour history of right medial thigh pain. Computed tomography scan revealed a right obturator hernia with small bowel obstruction. The hernia was successfully repaired laparoscopically without any need for small bowel resection. She was discharged on postoperative day 2 with an uneventful recovery and zero complications. Conclusion This case report highlights the importance of rapid diagnosis and repair of obturator hernia even in the setting of an improving clinical picture. It also demonstrates the safety of laparoscopic repair in this setting. more...
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- 2021
7. Obturator hernias: a systematic review of the literature
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Dimitrios Filippou, Prodromos Kanavidis, Nikolaos Garmpis, Christos Damaskos, Konstantinos Apostolou, Natasha Hasemaki, Dimitrios Tsapralis, Andreas Alexandrou, Dimitrios Schizas, and Konstantinos Kontzoglou more...
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medicine.medical_specialty ,business.industry ,Mortality rate ,Gold standard ,Hernia, Obturator ,Perioperative ,030230 surgery ,medicine.disease ,Surgery ,Bowel obstruction ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,Humans ,Abdomen ,Hernia ,Presentation (obstetrics) ,business ,Herniorrhaphy ,Abdominal surgery - Abstract
Obturator hernias (OH) are extremely rare hernias, accounting for 0.07–1% of all hernias. This is the first systematic review investigating their presentation, imaging, treatment outcomes, and recurrence rate. After a detailed search in electronic search engines, 74 studies matched our criteria. A review of these reports was conducted and the full texts were examined. A total of 146 patients with a mean age of 78.8 years were included in our analysis, with 40.1%, 29.9%, and 25.2% of patients suffering from either a right, a left or bilateral OH, respectively. OH were associated with non-specific symptoms and signs; bowel obstruction being the most common. Howship–Romberg sign was present in 56.2% of patients. Computed tomography (CT) scan was the most frequently used diagnostic modality, inversely associated with perioperative mortality. Mesh repair demonstrated a significantly improved perioperative morbidity rate, compared with non-mesh repair. Approximately 30% of patients underwent a laparoscopic operation, which was associated with significantly decreased morbidity and mortality rate as well as length of hospital stay, compared with the open repair. OHs are not associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair. more...
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- 2020
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8. Treatment outcomes of Kugel repair for obturator hernias: a retrospective study
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Yoshie Hosoi, Hiroyuki Fukano, Nozomi Shinozuka, and Hiroshi Asano
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Male ,medicine.medical_specialty ,Exploratory laparotomy ,medicine.medical_treatment ,Perforation (oil well) ,Operative Time ,lcsh:Surgery ,Peritonitis ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Medicine ,Humans ,Iliac spine ,Obturator hernia ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Mortality rate ,Hernia, Obturator ,Retrospective cohort study ,General Medicine ,lcsh:RD1-811 ,Length of Stay ,Middle Aged ,Surgical Mesh ,medicine.disease ,Surgery ,Bowel obstruction ,Kugel repair ,medicine.anatomical_structure ,Treatment Outcome ,Intestinal Perforation ,030220 oncology & carcinogenesis ,Female ,business ,Preperitoneal approach ,Intestinal Obstruction ,Surgical site infection ,Research Article - Abstract
Background We examined the validity and applicability of the Kugel repair approach for obturator hernias, whereby we placed a Kugel patch through the preperitoneal space after placing a short 5-cm skin incision just medial to the anterior iliac spine and 2 cm cranial to the expected origin of the internal inguinal ring. Methods We studied patients who underwent surgical Kugel repair for obturator hernias at the Department of General Surgery, Saitama Medical University between 2007 and 2017. We examined the operating time, length of hospital stay, postoperative complications, and mortality rate. Results Fifty-eight patients with obturator hernias presented with symptoms of small bowel obstruction. A Kugel approach was used in 53 patients and a midline approach was used in 5 patients with preoperative peritonitis. Of the 53 patients managed using the Kugel approach, 39 did not require intestinal resection; a mesh was used in all these patients. In the remaining 14 patients, intestinal resection was required and performed using the same approach; subsequently, a mesh was used successfully in 6 of these 14 patients. The overall median operating time was 47 min; the corresponding values for procedures with and without intestinal resection were 39 and 68 min, respectively. In terms of postoperative complications, operative mortality was not noted among patients without intestinal perforation; however, superficial surgical site infection developed in 2 patients. Among the 5 patients with preoperative peritonitis who underwent exploratory laparotomy via a midline incision, intestinal perforation was detected during surgery, and all patients required intestinal resection; none of the patients had received a mesh, and 2 patients died after surgery. Conclusions The Kugel repair approach was possible even in patients with obturator hernia requiring intestinal resection. However, for patients with perforations, open surgery should be performed after securing the surgical field through a midline incision. more...
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- 2020
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9. Internal hernia beneath the obturator nerve after robot‐assisted lateral lymph node dissection for rectal cancer: A case report and literature review
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Kazuaki Kobayashi, Yousuke Gohda, Hiroaki Uehara, Daisuke Sato, Akira Kubota, Akira Iwaya, Shirou Kuwabara, Itaru Chinen, Hitoshi Kameyama, Toshiyuki Yamazaki, Makoto Aoki, Naoyuki Yokoyama, and Tetsuya Otani more...
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Male ,Internal hernia ,Laparoscopic surgery ,medicine.medical_specialty ,Abdominal pain ,medicine.medical_treatment ,Dissection (medical) ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,Internal Hernia ,Humans ,Medicine ,Hernia ,Right Thigh ,Pelvis ,Rectal Neoplasms ,business.industry ,Hernia, Obturator ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Lymph Node Excision ,030211 gastroenterology & hepatology ,Obturator nerve ,medicine.symptom ,Obturator Nerve ,business - Abstract
A 63-year-old man who underwent robot-assisted laparoscopic low anterior resection and right lateral lymph node dissection (LLND) for rectal cancer presented with right thigh pain, nausea, vomiting, and abdominal pain on postoperative day 17. CT revealed dilated small bowel in the pelvis, and a small bowel loop was detected outside the internal iliac artery branch. Emergent laparoscopic surgery revealed the migration of the small bowel into the space beneath the right obturator nerve. The herniated bowel was reduced, and the obturator nerve was sharply dissected from the herniated bowel and preserved. The hernial orifice was left unrepaired. Postoperative recovery was uneventful, and the right thigh pain disappeared. It is important to consider the possibility of internal herniation beneath the obturator nerve after minimally invasive lateral lymph node dissection for rectal cancer. more...
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- 2020
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10. A case of acute appendicitis incarcerated in obturator hernia
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Rei Mizuno, Go Takeuchi, Yoko Ueda, Yuki Nomura, Shinji Nakamura, Atsuhito Omori, Riki Ganeko, Kyoichi Hashimoto, Yoshihiro Kubota, and Satoshi Nagayama
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Aged, 80 and over ,Acute Disease ,Gastroenterology ,Appendectomy ,Hernia, Obturator ,Humans ,Pain ,Female ,General Medicine ,Appendicitis ,Intestinal Obstruction - Abstract
An 85 year-old woman was transferred with a chief complaint of right thigh pain persisting for 5 days. Abdominal contrast-enhanced computed tomography clearly depicted a swollen appendix incarcerated in the right obturator cavity. She underwent an emergent laparoscopic appendectomy and the simultaneous repair of the obturator hernia. At laparoscopy, appendix was found to be incarcerated in the right obturator canal. The incarcerated appendix was successfully flushed out from the sac by spurting saline into the obturator hernia sac through the catheter inserted into the hernia sac. After a laparoscopic appendectomy, the hernia orifice was repaired using the uterine flap. The patient was discharged from the hospital without any sequelae. This report demonstrates a very rare case of obturator hernia incarcerated with appendix. Although patients with obturator hernia incarcerated with small intestine present with the symptoms related to bowel obstruction, patients with incarceration of appendix do not. Moreover, they would show no typical abdominal symptoms associated with acute appendicitis. Therefore, it is important to perform a radiological evaluation promptly to make a definitive diagnosis when a patient with persisting pain of the right thigh or right ileac fossa with a possibility of obturator hernia with incarceration of the appendix is encountered. more...
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- 2022
11. Is the Laparoscopic Approach Feasible for Reduction and Herniorrhaphy in Cases of Acutely Incarcerated/Strangulated Groin and Obturator Hernia?: 17-Year Experience from Open to Laparoscopic Approach
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Hiroshi Yoshida, Ryosuke Nakata, Tsutomu Nomura, Makoto Sukegawa, Hideyuki Suzuki, and Naoto Chihara
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Hernia, Inguinal ,030230 surgery ,Groin ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Prospective Studies ,Obturator hernia ,Laparoscopy ,Herniorrhaphy ,Reduction (orthopedic surgery) ,Aged ,Retrospective Studies ,Laparotomy ,medicine.diagnostic_test ,business.industry ,Hernia, Obturator ,Middle Aged ,Surgical Mesh ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Female ,030211 gastroenterology & hepatology ,business - Abstract
Purpose: Management strategies for acutely incarcerated/strangulated groin and obturator hernias may differ from institution to institution, although, conventionally, the open approach has...
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- 2019
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12. Evaluation of 4-hand reduction for obturator hernia with the guidance of sonography as a new treatment strategy: A retrospective study
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Yuki, Togawa, Kyohei, Kamihata, Yoshio, Nagahisa, and Kazuyuki, Kawamoto
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Male ,Intestines ,Humans ,Hernia, Obturator ,Female ,General Medicine ,Intestinal Obstruction ,Digestive System Surgical Procedures ,Retrospective Studies - Abstract
To evaluate the effectiveness of 4-hand reduction for obturator hernia with the guidance of sonography (FROGS) as a new treatment strategy for obturator hernia. Since November 2019, FROGS was performed for all patients with obturator hernia at our emergency department. We retrospectively compared the clinical data of 20 patients who underwent FROGS (after FROGS group) to those of 23 patients who did not (before FROGS group). All patients except one were female. The male-to-female ratio, age, duration of symptoms, lesion site, and predisposing factors did not significantly differ between groups. However, the diameter of the prolapsed bowel and the body mass index of the after FROGS group were significantly larger and lower, respectively. Manual reduction was successfully performed for all 20 patients in the after FROGS group, and bowel resection was avoided for all 20 cases. However, 14 patients in the before FROGS group underwent manual reduction; of these, only one was successfully treated using a method other than FROGS, and 8 patients underwent bowel resection. There were no significant differences between groups in terms of postprocedural complications or mortality within 30 days of hernia presentation. The FROGS technique was safe and reproducible and could be used as the first choice of treatment for patients with obturator hernia. more...
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- 2022
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13. Small Bowel Obstruction Due to Incarcerated Obturator Hernia: Successfull Surgical Management with Modified Mesh-Plug Hernioplasty
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Júlio Marques, Carlos Casimiro, Bruno Rafael da Silva Barbosa, Liliana Duarte, and José Carlos Pereira Pinto
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Abdominal pain ,medicine.medical_specialty ,Exploratory laparotomy ,medicine.medical_treatment ,Abdominal wall ,Laparotomy ,Intestine, Small ,medicine ,Humans ,Hernia ,Obturator hernia ,Herniorrhaphy ,Aged ,Aged, 80 and over ,business.industry ,Abdominal Wall ,Hernia, Obturator ,General Medicine ,Articles ,Surgical Mesh ,medicine.disease ,Femoral hernia ,digestive system diseases ,Surgery ,Abdominal Pain ,Bowel obstruction ,medicine.anatomical_structure ,Female ,medicine.symptom ,business ,Intestinal Obstruction - Abstract
Patient: Female, 93-year-old Final Diagnosis: Incarcerated obturator hernia Symptoms: Diffuse abdominal pain Medication:— Clinical Procedure: Hernioplasty Specialty: Surgery Objective: Rare disease Background: Obturator hernia is an uncommon (0.07-1% incidence rate) subtype of hernia of the abdominal wall, with its incarceration being a rare cause of bowel obstruction. Obturator hernia has a higher incidence in elderly women and in malnourished people. This type of hernia has the highest morbidity and mortality rates of all abdominal wall hernias. This article reports a case of an emaciated 93-year-old woman who presented with small bowel obstruction due to incarcerated obturator hernia, successfully managed surgically with a modified mesh-plug hernioplasty. Case Report: An emaciated 93-year-old woman presented with diffuse abdominal pain, more intense on the right iliac fossa, radiating to the right thigh, with 8-h evolution and associated with dark-colored vomiting but normal bowel transit. This patient had a surgical history of right Richter´s femoral hernia, strangulated, with previous intestinal resection and a right femoral hernioplasty. A computed tomography (CT) scan revealed an incarcerated obturator hernia on the right side containing a short segment of small intestine. The patient underwent an exploratory laparotomy and a mesh-plug hernioplasty. During follow-up, there was no evidence of recurrence or complications. Conclusions: Obturator hernia diagnosis is challenging due to its rarity and its signs and symptoms being often unspecific. CT scan has the highest sensitivity and is the best diagnostic tool. Surgical management is the only possible treatment for obturator hernia. Awareness of this condition is essential to allow an earlier approach and attempt to mitigate the associated high morbidity and mortality rates. more...
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- 2021
14. An elderly woman's limp: Obturator hernia as a rare cause of small bowel obstruction
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Sarit Badiani, Christophe R. Berney, Angelina Di Re, and Jason Diab
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medicine.medical_specialty ,Movement Disorders ,business.industry ,Limp ,Hernia, Obturator ,medicine.disease ,Surgery ,Bowel obstruction ,Intestine, Small ,medicine ,Humans ,Female ,Obturator hernia ,medicine.symptom ,Family Practice ,business ,Intestinal Obstruction ,Aged - Published
- 2021
15. An extraordinary cause of intestinal obstruction, incarcerated obturator hernia
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Ismail, Aydin and Ilker, Sengul
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Aged, 80 and over ,Laparotomy ,Hernia, Obturator ,Humans ,Female ,Tomography, X-Ray Computed ,Intestinal Obstruction ,Abdominal Pain - Abstract
Presenting an extraordinary cause of intestinal obtuction, leading to incarcerated obturator hernia.We present a rare case of obturator hernia in a 90-year-old female, who presented with a three-day history of inability to defecate and abdominal pain, distension, and vomiting on the day of presentation. Hours later, a computed tomography scan revealed a bowel obstruction secondary to a right-sided obturator hernia. She underwent an emergency exploratory laparotomy and the incarcerated bowel was reduced with a repairment of the hernial defect. The patient demonstrated an uneventful postoperative period and was discharged on hospital day four.Obturator hernia, a rare anterior abdominal wall hernia, in which abdominal contents protrude through the obturator canal, is an unusual cause of intestinal obstruction. It has one of the highest mortality rates of all abdominal wall hernias with a challenging diagnosis that can still be misleading even to the most experienced surgeons.Providers should be aware of inability to defecate, abdominal pain, distension, and vomiting that may be due to an existence of incarcerated/strangulated obturator hernia, thus the further evaluation should be considered as the elements of the clinical picture are incongruent.Emergencies, Hernia, Intestines, Intestinal obstruction, Obturator.Si presenta il caso di un’occlusione intestinale per una eccezionale incarcerazione di un’ernia otturatoria. Si trattava di una donna di 90 anni con crisi di stipsi da tre giorni accompagnata da dolori addominali, addome disteso e vomito fin dal ricovero. Una tomografia computerizzata di ore dopo ha dimostrato trattarsi di un’occlusione intestinale a livello della porta erniaria otturatoria di destra. Alla laparotomia esplorativa d’urgenza si è provveduto a ridurre in addome l’intestino incarcerato e alla riparazione della porta erniaria. Il decorso postoperatorio è stato privo di complicazioni, e la paziente è stata dimessa dall’ospedale in quarta giornata postoperatoria. L’ernia otturatoria è una di quelle rare della parete addominale anteriore, con protrusione del contenuto addominale nel canale otturatorio, e causa insolita di occlusione intestinale. È caratterizzata da uno dei più alti tassi di mortalità tra tutte le ernie della parete addominale, di diagnosi impegnativa e fuorviante anche per i chirurghi più esperti. In conclusione gli operatori sanitari dovrebbero essere avvertiti che la stipsi prolungata, insieme a dolore e distensione addominale e vomito possono essere dovuti ad un’ernia otturatorio incarcerata o strangolata, e procedere ad una ulteriore fase diagnostica nel caso di incongruenza degli elementi del quadro clinico. more...
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- 2021
16. Case report of ureter obturator hernia and literature review analysis
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Siyu Zhang, Shaokun Hong, Yongqiang Hong, Yuedong Chen, Xiuying Kong, and Yuxin Zhang
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medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Case Report ,Hydronephrosis ,urologic and male genital diseases ,Abdominal wall ,03 medical and health sciences ,0302 clinical medicine ,Ureter ,medicine ,Humans ,Ureteral Diseases ,Hernia ,Ureteral stent implantation ,Obturator hernia ,Aged ,business.industry ,Hernia, Obturator ,General Medicine ,Hernia repair ,medicine.disease ,Diseases of the genitourinary system. Urology ,Surgery ,medicine.anatomical_structure ,Reproductive Medicine ,Ureteral obturator hernia ,Female ,030211 gastroenterology & hepatology ,Kidney stones ,RC870-923 ,business ,Pyelogram - Abstract
Background Ureteral obturator hernia is a rare condition, usually found accidentally during imaging examinations, or found during surgery. Ureteral hernia can easily lead to ureteral obstruction and hydronephrosis. Long-term hydronephrosis may lead to kidney damage and infection, and eventually cause kidney failure. As of December 31, 2020, there are only 2 literature reports. Case presentation This article reports a 67-year-old female patient with no symptoms. The computed tomography (CT) scan of the urinary system to show the left kidney and ureter had hydrops. The CTU imaging of the urinary tract revealed the left ureter pelvis herniated into the parietal pelvic fascia was accompanied by tortuosity and left hydronephrosis. She underwent laparoscopic abdominal wall hernia repair on April 29, 2020, and she recovered well. Conclusions Ureteral obturator hernia is an uncommon condition. The clinical symptoms are non-specific, including unclear abdominal pain, until the appearance of obstructive diseases of the urinary tract, such as renal insufficiency, urinary tract infection, kidney stones, and uremia. A comprehensive review of the literature shows that it is difficult to make an accurate diagnosis based on physical examination alone.Early urography can improve the possibility of accurate diagnosis. When a patient suffers from impaired renal function, timely surgical treatment can avoid deterioration of renal function. more...
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- 2021
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17. The Feasibility and Potential Advantages of Laparoscopic Management of Incarcerated Obturator Hernia Over the Open Approach
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Zhi Zhang, Jianmao Yuan, Zhigang Gu, Zhengbin Tu, Weixian Huang, and Genhai Shen
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Treatment Outcome ,Feasibility Studies ,Hernia, Obturator ,Humans ,Laparoscopy ,Length of Stay ,Herniorrhaphy ,Retrospective Studies - Abstract
The purpose of this study was to explore the feasibility and potential advantages of laparoscopic surgery in the treatment of incarcerated obturator hernia (IOH).Clinical data of 23 patients with IOH who underwent emergency surgery at our hospital from June 2015 to October 2020 were retrospectively analyzed. The clinical characteristics and surgery outcomes were compared between the laparoscopic group, open group, and the previously published data.Twelve patients with IOH were treated by laparoscopic management, while 11 patients with IOH underwent open surgery. There was no statistically significant difference in preoperative general data between the 2 groups, while the laparoscopic group had less intraoperative blood loss, shorter postoperative hospital stay, and lower postoperative complications compared with open group. Furthermore, when compared with the open group reported in previous literature, which showed similar conclusions.Laparoscopic surgery for IOH showed more favorable advantages including less intraoperative blood loss, shorter postoperative hospital stay, and lower postoperative complications compared with an open approach, which is a safe and feasible minimally invasive strategy and has certain advantages. more...
- Published
- 2021
18. Laparotomy with suture repair is the most common treatment for obturator hernia: a scoping review
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Jacob Rosenberg, Mikkel Andreas Holm, Siv Fonnes, and Kristoffer Andresen
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Laparoscopic surgery ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Recurrence ,Laparotomy ,medicine ,Humans ,Hernia ,Obturator hernia ,education ,Herniorrhaphy ,education.field_of_study ,Sutures ,business.industry ,Hernia, Obturator ,Vascular surgery ,Surgical Mesh ,medicine.disease ,Surgery ,Cardiothoracic surgery ,Laparoscopy ,business ,Abdominal surgery - Abstract
Obturator hernias are rare and associated with high mortality. However, the optimal surgical approach remains unknown. We aimed to investigate the available evidence and examine the surgical details regarding obturator hernia defect closure as well as the recurrence rates of the different approaches. We reported this scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews) and registered the protocol online. A comprehensive literature search in five different databases was conducted. The population was patients undergoing surgery for obturator hernia. Articles were included for data charting if the management of the hernia defect was reported. Data regarding surgical details, and hernia recurrence were extracted. A total of 1299 patients from 313 articles were included. In total, 937 patients underwent open obturator hernia repair, in which 992 hernias were repaired (including some bilateral obturator hernias). A total of 295 patients underwent laparoscopic repair for 341 obturator hernias, and for the remaining 67 patients, type of surgery was not reported. For open surgery, suture repair was the most common method of repair (n = 508, 51%) with a recurrence rate of 10%. For laparoscopic surgery, the most common repair of the defect was mesh repair (n = 299, 88%) with no reported recurrences. Open surgery with primary suture repair is the most common method of repair for obturator hernia but is associated with a recurrence rate of 10%. Laparoscopic mesh repair is becoming more common and have seemingly very low recurrence rates and may be a better method of repair. more...
- Published
- 2021
19. Strangulated obturator hernia with ischaemic and perforated small bowel
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Jun Sen Chuah and Henry Tan Chor Lip
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medicine.medical_specialty ,Hernia ,business.industry ,Hernia, Obturator ,General Medicine ,medicine.disease ,Surgery ,Intestinal Perforation ,Abdomen ,Intestine, Small ,medicine ,Humans ,Obturator hernia ,business ,Intestinal Obstruction - Published
- 2021
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20. Obturator hernia of Richter type: a diagnostic dilemma
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Yuwaraja Neduchelyn, Cathal Hayes, Karl Schmidt, and Ivan Ivanovski
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0301 basic medicine ,medicine.medical_specialty ,Vomiting ,medicine.medical_treatment ,Pain ,Case Report ,030105 genetics & heredity ,Groin ,03 medical and health sciences ,0302 clinical medicine ,Intestine, Small ,medicine ,Humans ,Hernia ,Obturator hernia ,Pelvis ,Herniorrhaphy ,Aged, 80 and over ,business.industry ,Malnutrition ,Hernia, Obturator ,Obturator canal ,General Medicine ,Surgical Mesh ,medicine.disease ,Hernia repair ,digestive system diseases ,Surgery ,Bowel obstruction ,surgical procedures, operative ,medicine.anatomical_structure ,Thigh ,Abdomen ,Female ,Laparoscopy ,business ,Tomography, X-Ray Computed ,030217 neurology & neurosurgery ,Intestinal Obstruction - Abstract
An 85-year-old malnourished woman presented with symptoms of small bowel obstruction of uncertain aetiology. She had presented numerous times over the previous 2 years with symptoms of left groin and thigh pain, vomiting and abdominal distension. A CT of her abdomen and pelvis ultimately revealed a left-sided pelvic hernia, between the obturator internus and pectineal muscles. This was consistent with an obturator hernia. Diagnostic laparoscopy confirmed an obturator hernia of Richter type, incarcerated within the left obturator canal. Reduction revealed a hernia sac containing viable small bowel. A primary repair was performed using a double-layer suture technique to both close and plug the hernia defect. The patient rapidly recovered following hernia repair, with resolution of all previous long-standing symptoms. This case exemplifies the typical presentation of an obturator hernia and the diagnostic challenge it poses to clinicians. more...
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- 2020
21. Obturator hernia: An uncommon case of intestinal obstruction
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Cristina Chocarro Huesa, Aitor Ariceta López, Rocío Ruiz Marzo, and Héctor Lajusticia Andrés
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medicine.medical_specialty ,business.industry ,General Engineering ,medicine ,Hernia, Obturator ,Humans ,Obturator hernia ,Tomography, X-Ray Computed ,medicine.disease ,business ,Intestinal Obstruction ,Surgery - Published
- 2020
22. An obturator hernia of the Richter type - a video vignette
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Raj Chelyn, Cathal Hayes, Karl Schmidt, and Ivan Ivanovski
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medicine.medical_specialty ,Vignette ,business.industry ,General surgery ,Gastroenterology ,medicine ,Hernia, Obturator ,Humans ,Obturator hernia ,business ,medicine.disease ,Intestinal Obstruction - Published
- 2020
23. Diagnosis and treatment of obturator hernia: retrospective analysis of 86 clinical cases at a single institution
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Mingtian Wei, Xing Yuan, Chaoyang Gu, Zhengzheng Li, and Ziqiang Wang
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,lcsh:Surgery ,Peritonitis ,Anastomosis ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Diagnosis ,Medicine ,Humans ,Hernia ,Obturator hernia ,Elective surgery ,Intestinal necrosis ,Mortality ,Aged ,Retrospective Studies ,Aged, 80 and over ,Surgical treatment ,business.industry ,Mortality rate ,Hernia, Obturator ,General Medicine ,Bowel resection ,lcsh:RD1-811 ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,business ,Tomography, X-Ray Computed ,Surgery Department, Hospital ,Research Article - Abstract
Background: To explore the clinical characteristics, diagnosis and treatment of obturator hernia.Methods: Eighty-six patients who were diagnosed as obturator hernia by abdominal CT in the Department of Gastrointestinal Surgery of our hospital between 2009 and 2019 were enrolled in this study. Patient characteristics, surgical method, postoperative complications and mortalities were retrospectively reviewed, and the patients were followed by telephone or clinic visit to check for the recurrence.Results: 30 days mortality rate of 5.5% and 46.1% were observed in surgery group and non-surgery group, respectively. Surgery was performed as an emergency procedure in 59 cases and elective procedure in 14 cases depending on different hernia contents, intestinal necrosis and signs of peritonitis. In the emergency surgery group, segmental intestinal resection with anastomosis was performed in 24 patients(24/59, 40.7%). There were 4 deaths(4/59, 6.8%) in this group ,all of which occurred in patients undergoing SI resections. In contrast, no bowel resection, postoperative complications, or death occurred in the elective surgery group. 3 -year recurrence rates of 5.1% (3/59)and 7.1%(1/14) were observed in the emergency surgery and the elective surgery group, respectively. Conclusions: CT examination plays an important role in improving the diagnostic rate of obturator hernia. In elderly people with comorbidities, timely surgical treatment is the key to improve the efficacy of obturator hernia and prevent the deterioration of the condition. In addition, postoperative mortality is significantly associated with bowel resection and postoperative complications. more...
- Published
- 2020
24. Intestinal blood flow evaluation using the indocyanine green fluorescence imaging method in a case of incarcerated obturator hernia: A case report
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Kota Ishida, Atsuko Okamoto, Keigo Nakashima, Keigo Hara, Yukio Nakabayashi, Ryusuke Ito, and Shunjin Ryu
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Laparoscopic surgery ,Indocyanine Green ,medicine.medical_specialty ,medicine.medical_treatment ,Ischemia ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Intestine, Small ,medicine ,Humans ,Obturator hernia ,Herniorrhaphy ,Fluorescent Dyes ,Aged, 80 and over ,business.industry ,Optical Imaging ,Hernia, Obturator ,General Medicine ,Blood flow ,Intestinal necrosis ,medicine.disease ,digestive system diseases ,Surgery ,chemistry ,030220 oncology & carcinogenesis ,Incarcerated hernia ,030211 gastroenterology & hepatology ,Female ,Laparoscopy ,business ,Indocyanine green ,Intestinal Obstruction ,Indocyanine green fluorescence - Abstract
In surgery for incarcerated hernia, intestinal blood flow is an important factor in intraoperative decision-making given that irreversible ischemia can result in intestinal necrosis. Here, we report a case of incarcerated obturator hernia in which the bowel was successfully preserved by evaluating intestinal blood flow with the indocyanine green fluorescence imaging method. A woman in her 80s was diagnosed with incarcerated right obturator hernia, and a laparoscopic operation was performed. The small bowel tissue that had been incarcerated exhibited dark red discoloration. Fluorescence examination of the bowel wall indicated that the ischemic changes were reversible, and accordingly, the bowel was not resected. The postoperative course was uneventful. The indocyanine green fluorescence imaging method is a useful new source of evidence that will improve intraoperative decision-making regarding bowel ischemia. more...
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- 2020
25. Diagnostic difficulties in obturator hernia: a rare case presentation and review of literature
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Jeyakumar Sundaraj, Tharun Ganapathy Chitrambalam, Pradeep Joshua Christopher, and Sundeep Selvamuthukumaran
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0301 basic medicine ,medicine.medical_specialty ,general surgery ,Perforation (oil well) ,030105 genetics & heredity ,03 medical and health sciences ,0302 clinical medicine ,Rare Disease ,medicine ,Humans ,gastrointestinal surgery ,Hernia ,Obturator hernia ,Laparoscopy ,Aged ,medicine.diagnostic_test ,business.industry ,Hernia, Obturator ,groin pain ,Obturator canal ,General Medicine ,ultrasonography ,medicine.disease ,Occult ,digestive system diseases ,Surgery ,Inguinal hernia ,stomatognathic diseases ,surgical procedures, operative ,Acute abdomen ,Female ,medicine.symptom ,business ,small intestine ,030217 neurology & neurosurgery - Abstract
Hernia arising from obturator canal is rare and it contributes to about less than 1% of incidence of all hernias. Diagnosing an obturator hernia clinically is a challenging one and nearly impossible. These hernias usually present as an intestinal obstruction as more than 50% of obturator hernias goes in for strangulation. Here, we report an unusual presentation of an obturator hernia in a 70-year-old woman who presented to emergency room with acute abdomen and uncomplicated reducible inguinal hernia. Radiological imaging showed obstructed inguinal hernia while on diagnostic laparoscopy, a strangulated and perforated obturator hernia of Richter’s type was seen in addition to an uncomplicated inguinal hernia. Obturator hernia, although very rare, is associated with high morbidity and mortality as it is often underdiagnosed as in our case. Laparoscopy bailed us out from missing out a perforation from an occult obturator hernia. more...
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- 2020
26. Obturator hernia: Clinical analysis of 11 patients and review of the literature
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Jinyoung Park
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medicine.medical_specialty ,Abdominal pain ,Abdominal Hernia ,medicine.medical_treatment ,Observational Study ,Body Mass Index ,Abdominal wall ,03 medical and health sciences ,0302 clinical medicine ,Laparotomy ,medicine ,Humans ,Hernia ,030212 general & internal medicine ,Obturator hernia ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Hernia, Obturator ,Obturator canal ,computed tomography ,General Medicine ,medicine.disease ,intestinal obstruction ,Surgery ,Bowel obstruction ,obturator hernia ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,medicine.symptom ,business ,Tomography, X-Ray Computed ,Research Article - Abstract
Obturator hernia is a relatively rare type of abdominal hernia, in which abdominal contents protrude through the obturator canal, a condition that can lead to small bowel obstruction. Its rarity and nonspecific signs and symptoms make a preoperative diagnosis difficult. The present study analyzed the clinical manifestations, diagnostic methods and operative treatment outcomes in patients with obturator hernia. Between January 2012 and October 2019, 1028 adults underwent surgical repair of abdominal wall hernia at the Department of Surgery, Kyungpook National University Hospital. The medical records of eleven patients who were treated for small bowel obstruction due to obturator hernia were retrospectively evaluated. Patient characteristics, clinical presentation, preoperative radiological diagnosis, operative findings, treatment, complications, and outcomes were recorded. All 11 patients were elderly women, with a mean age of 80.2 years (range, 71–87 years). Their mean body mass index was 17.9 kg/m2 (range, 11.9–22.2 kg/m2). Symptoms at presentation were abdominal pain and vomiting, with a mean duration of symptoms prior to admission of 5.6 days (range, 1–15 days). Based on abdominopelvic computed tomography (CT) scans, all 11 patients were preoperatively diagnosed with obturator hernia, followed by laparoscopic exploration or laparotomy as soon as possible. Of the 11 patients, 6 (54.5%) had left-sided, four (36.4%) had right-sided, and one (9.1%) had bilateral obturator hernias. Three patients (27.3%) required resection of the ileum due to perforation or strangulation. All underwent simple closure of the hernia defect with interrupted or purse-string sutures. Ten patients recovered uneventfully, whereas one had wound seroma and ileus. Recurrence has not been observed in the 8 surviving patients. Obturator hernia should be included in the differential diagnosis of intestinal obstruction of unknown origin, especially in emaciated elderly women with chronic disease. Early surgical intervention without delay is imperative to avoid postoperative morbidity and mortality associated with intestinal strangulation due to obturator hernia. Obturator hernia can be sufficiently repaired with simple suture closure without mesh. more...
- Published
- 2020
27. Does preoperative enhanced CT predict requirement of intestinal resection in the patients with incarcerated myopectineal hernias containing small bowel?
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A, Kohga, A, Kawabe, K, Yajima, T, Okumura, K, Yamashita, J, Isogaki, K, Suzuki, K, Muramatsu, and A, Komiyama
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Aged, 80 and over ,Hernia, Obturator ,Humans ,Hernia, Inguinal ,Tomography, X-Ray Computed ,Herniorrhaphy ,Intestinal Obstruction ,Retrospective Studies - Abstract
Bowel wall enhancement on CT imaging is considered one of the useful features for the prediction of the presence of irreversible ischemic change in patients with small bowel obstruction. However, the applicability of CT imaging in patients with incarcerated hernias has not been investigated in detail. The aim of this retrospective study was to evaluate the feasibility of preoperative CT findings for the prediction of the presence of irreversible ischemic change in patients with incarcerated hernias containing small bowel.Included in this study were 76 patients who underwent surgery for preoperatively diagnosed incarcerated hernias containing small bowel (27 inguinal hernias, 37 femoral hernias and 12 obturator hernias) at our hospital between January 2011 and June 2020. The preoperative clinicoradiological features were compared between the groups, and predictors for intestinal resection were evaluated.Nineteen patients required intestinal resection (Resection group), and the other 57 patients did not require intestinal resection (Nonresection group). Multivariate analyses revealed that age ≥ 80 years (p = 0.018, odds ratio = 6.604) and the absence of bowel wall enhancement (p = 0.032, odds ratio = 51.200) were independent predictors for intestinal resection. In resected specimens, all patients with an absence of bowel wall enhancement on preoperative enhanced CT had ischemic changes extending beyond the muscularis propria.Preoperative enhancement CT yields useful information for the prediction of the presence of irreversible ischemic change in patients with incarcerated hernias containing small bowel. more...
- Published
- 2020
28. [Staged bilateral total extraperitoneal allohernioplasty by e-TEP in a patient with recurrent oblique inguinal hernia on the left and combined strangulated femoral hernia on the right]
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O. A. Kosivtsov, L. A. Ryaskov, I V Mikhin, and A A Polyakov
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medicine.medical_specialty ,medicine.medical_treatment ,Hernia, Inguinal ,030230 surgery ,03 medical and health sciences ,Necrosis ,0302 clinical medicine ,Laparotomy ,Intestine, Small ,medicine ,Perforated ulcer ,Humans ,Hernia ,Laparoscopy ,Herniorrhaphy ,Aged ,medicine.diagnostic_test ,business.industry ,Femoral canal ,Hernia, Obturator ,Endoscopy ,General Medicine ,medicine.disease ,Femoral hernia ,Occult ,Hernia, Femoral ,Surgery ,Inguinal hernia ,medicine.anatomical_structure ,030211 gastroenterology & hepatology ,business - Abstract
A case of two-stage minimally invasive surgical treatment of an elderly patient with bilateral inguinal hernia is presented: a recurrent oblique on the left, combined (femoral, obturator, oblique and direct inguinal) on the right with incarceration and necrosis of the small intestine in the femoral canal. Previously, the patient underwent closure of perforated ulcer of duodenum from upper-midline laparotomy, epicystostomy, transvesical adenomectomy from the lower-midline laparotomy. The first stage we performed diagnostic laparoscopy, minilaparotomy, reduction and resection of necrotic small intestine loop. The second stage was carried endovideoscopic total extraperitoneal allohernioplasty by the method of Extended-View Totally Extraperitoneal (e-TEP) on two sides. The positive results of the treatment indicate a high efficiency of video endoscopic alloplasty of occult hernias in a complex case. To diagnose and perform adequate surgical intervention with a combined femoral hernia, when the obturator and inguinal hernias are formed, but clinically do not manifest themselves, it is possible only with endoscopic examination of potential sites of hernia formation in the inguinal region, which is not possible with open plastic hernia of the inguinal region.Представлено наблюдение двухэтапного минимально инвазивного хирургического лечения пациента старческого возраста с двусторонней паховой грыжей: рецидивной косой слева, комбинированной (бедренной, запирательной, косой и прямой паховой) справа с ущемлением и некрозом тонкой кишки в бедренном канале. Ранее пациент перенес ушивание перфоративной язвы двенадцатиперстной кишки из верхне-срединной лапаротомии, эпицистостомию, транспузырную аденомэктомию из нижне-срединной лапаротомии. Первым этапом мы выполнили диагностическую лапароскопию, минилапаротомию, низведение и резекцию некротизированной петли тонкой кишки. Вторым этапом была произведена эндовидеоскопическая тотальная экстраперитонеальная аллогерниопластика по методике Extended-View Тotally Еxtraperitoneal (е-ТЕР) с двух сторон. Положительные результаты проведенного лечения свидетельствуют о высокой эффективности видеоэндоскопического варианта аллопластики оккультных грыж в сложном случае. Диагностировать и выполнить адекватное хирургическое вмешательство при комбинированной бедренной грыже, когда запирательная и паховые грыжи сформированы, но клинически себя не проявляют, возможно только при эндоскопическом осмотре потенциальных мест образования грыж в паховой области, что не представляется возможным при открытой пластике грыж паховой области. more...
- Published
- 2020
29. Impact of age on groin hernia profiles observed during laparoscopic transabdominal preperitoneal hernia repair
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Tsuyoshi Notake, Shinichi Miyagawa, Akira Shimizu, Toshiki Kikuchi, Akira Kobayashi, Takuma Arai, Shiro Miwa, Takahide Yokoyama, Noriyuki Kitagawa, Hiroaki Motoyama, and Kentaro Fukushima
- Subjects
Adult ,Male ,medicine.medical_specialty ,Hernia ,medicine.medical_treatment ,Hernia, Inguinal ,Groin ,03 medical and health sciences ,0302 clinical medicine ,Odds Ratio ,medicine ,Humans ,Obturator hernia ,Herniorrhaphy ,Aged ,Retrospective Studies ,Aged, 80 and over ,Analysis of Variance ,Univariate analysis ,business.industry ,Incidence ,Age Factors ,Hernia, Obturator ,Middle Aged ,medicine.disease ,Femoral hernia ,Hernia repair ,Occult ,Hernia, Femoral ,digestive system diseases ,Surgery ,stomatognathic diseases ,surgical procedures, operative ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,business ,Abdominal surgery - Abstract
How increasing age affects the characteristics of groin hernia remains uncertain. This study evaluated the association between age and the type of groin hernia, especially with respect to its multiplicity, observed during laparoscopic transabdominal preperitoneal (TAPP) hernia repair. We retrospectively evaluated 634 consecutive patients with primary groin hernia who underwent laparoscopic TAPP repair between October 2000 and June 2017. Patients were stratified into 4 age groups more...
- Published
- 2018
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30. Impact of bowel resection on postoperative mortality in patients with obturator hernias
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T. Sonoda, M. Miyazaki, Y. Hisamatsu, M. Yamagata, A. Fukuda, T. Yoshida, S. Tanaka, and H. Wang
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,030230 surgery ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Japan ,Risk Factors ,medicine ,Humans ,In patient ,Postoperative Period ,Obturator hernia ,Digestive System Surgical Procedures ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Abdominal Wall ,Hernia, Obturator ,Bowel resection ,Surgical Mesh ,medicine.disease ,digestive system diseases ,Surgery ,Intestines ,Bowel obstruction ,Blood pressure ,Postoperative mortality ,030220 oncology & carcinogenesis ,Female ,Base excess ,business ,Intestinal Obstruction ,Abdominal surgery - Abstract
The purpose of this study was to identify any potential correlation between postoperative mortality and bowel resection in patients with obturator hernias. In total, 21 patients who underwent emergency surgery for a primary incarcerated obturator hernia during a 9-year period were retrospectively assessed regarding the correlation between postoperative mortality within 30 days from surgery and bowel resection. The 21 hernias occurred in 20 women and 1 man. The mean age at presentation was 83.3 years. Eight hernias required bowel resection, and operations using mesh were performed for eight hernias. Complications occurred in association with nine hernias, and three patients died. Postoperative mortality was correlated with complications (p = 0.016) and bowel resection (p = 0.010). Patients undergoing bowel resection had a significantly longer operation time (p = 0.009) and a higher rate of postoperative complications (p = 0.018). The systolic blood pressure, pH, and base excess were significantly lower in patients who did than did not undergo bowel resection (p = 0.017, 0.009, and 0.015, respectively). As the aging population continues to expand, the number of patients with obturator hernias is speculated to increase. Elderly people with comorbidities require immediate operative procedures because their general condition tends to be exacerbated by bowel obstruction. Postoperative management may be carefully performed in patients with bowel resection because the postoperative mortality rates may be higher in these patients. more...
- Published
- 2018
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31. Obturator hernia
- Author
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Hiroaki, Nakagawa, Tsukasa, Asakura, and Sugihiro, Hamaguchi
- Subjects
Aged, 80 and over ,Treatment Outcome ,Hernia, Obturator ,Humans ,Female ,General Medicine ,Tomography, X-Ray Computed - Published
- 2022
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32. Midline Extraperitoneal Approach for Obturator Hernia Repair
- Author
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Keisa Takeda, Hirofumi Konn, Masahiko Koike, and Yuji Otsuki
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Abdominal Hernia ,Hernia, Inguinal ,030230 surgery ,Aspiration pneumonia ,Pneumonia, Aspiration ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Obturator hernia ,Colectomy ,Herniorrhaphy ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Abdominal Wall ,Hernia, Obturator ,Postoperative complication ,Obturator canal ,General Medicine ,Bowel resection ,Surgical Mesh ,medicine.disease ,Hernia, Femoral ,Surgery ,Bowel obstruction ,030220 oncology & carcinogenesis ,Female ,Median body ,business ,Intestinal Obstruction - Abstract
Obturator hernia (OH) is a rare condition that accounts for 0.073-1% of abdominal hernias and 0.48% of bowel obstructions. OH frequently occurs in elderly women, with an incidence that increases with age. The only treatment for OH is surgical intervention, and the approaches used vary greatly. Consequently, a well-defined consensus has not yet emerged. We assessed the efficiency and safety of the midline extraperitoneal approach for OH. Six patients with OH repaired using the midline extraperitoneal approach at KKR Sapporo Medical Center between April 2011 and January 2016 were included in the study. We retrospectively evaluated the patient characteristics, intraoperative findings, and the postoperative course. All patients were elderly women [median age, 90 (range, 79-92) years], with a median body mass index of 17.0 (range, 15.6-18.3) kg/m2 at presentation. All had symptoms associated with bowel obstruction: two patients presenting with leg pain had the Howship-Romberg sign. In two patients, bowel resection was required because of irreversible ischemic changes. Five patients had coexisting femoral and inguinal hernias that were repaired by bilateral mesh repair. One patient had aspiration pneumonia as a postoperative complication. All patients were discharged alive, without infection or recurrence. OH can be efficiently and safely repaired using the midline extraperitoneal approach. This approach establishes the diagnosis of OH, avoids injuring obturator vessels, gives improved exposure of the obturator canal, enables identification and simultaneous repair of other pelvic hernias, and facilitates bowel resection. This approach reduces the risk of mesh infection in patients undergoing bowel resection. more...
- Published
- 2018
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33. Bowel obstruction secondary to incarcerated obturator hernia
- Author
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Dawei Chen, Xiaojun Wang, and Zhewei Fei
- Subjects
medicine.medical_specialty ,Abdominal Hernia ,medicine.medical_treatment ,lcsh:Surgery ,030230 surgery ,obturator ,hernia ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,laparotomy ,Laparotomy ,medicine ,Humans ,Hernia ,Obturator hernia ,bowel obstruction ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Hernia, Obturator ,Retrospective cohort study ,computed tomography ,Bowel resection ,lcsh:RD1-811 ,medicine.disease ,digestive system diseases ,Surgery ,Bowel obstruction ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Abdomen ,Female ,Radiology ,business ,Tomography, X-Ray Computed ,Intestinal Obstruction - Abstract
Summary Background/Objective Obturator hernia is rare type of abdominal hernia and its diagnosis usually is made intraoperatively for bowel obstruction or computed tomography (CT) scans of the abdomen. The aim of this study was to review patient's records with respect to clinical manifestation, CT scan findings, and operative outcomes. Methods From April 2009 to January 2015, six female patients with incarcerated obturator hernia underwent urgent operation for acute intestinal obstruction. The medical records were reviewed with respect to clinical manifestation, findings of CT scan and the outcomes of operation. Results The median age of patients was 83 years (range, 79–87 years) and the body mass index was 21.61 ± 0.52 kg/m 2 . CT scans of abdomen demonstrated that intestinal obstruction secondary to obturator hernia, consistency with operative findings. Partial bowel resection was performed in two of six patients because of necrosis of incarcerated obturator hernia. The hernia was repaired with interrupted sutures. Lung infection occurred in one patient, and wound infection in another. One recurrence was observed and two patients died from the unrelated diseases during the period of follow-up. Conclusion The diagnosis of obturator hernia can be made by CT scan preoperatively, and the obturator hernia should be suspected when an unexplained bowel obstruction in elderly, thin women occurs. more...
- Published
- 2017
34. When is Thigh Pain a Problem?
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Sunu Philip, Prakash Jayanthi, and Peter P Lopez
- Subjects
Aged, 80 and over ,medicine.medical_specialty ,Vomiting ,business.industry ,Hernia, Obturator ,Pain ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Thigh ,030220 oncology & carcinogenesis ,Emergency Medicine ,Thigh pain ,Physical therapy ,Humans ,Medicine ,Female ,Emergency Service, Hospital ,Tomography, X-Ray Computed ,business ,Intestinal Obstruction - Published
- 2018
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35. Aggressive angiomyxoma of the pelvis presenting as an obturator hernia
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Orcun, Yalav, Ugur, Topal, Ayse Gizem, Unal, and Kivilcım Eren, Erdogan
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Adult ,Hernia, Obturator ,Humans ,Female ,Myxoma ,Pelvic Neoplasms - Abstract
İNTRODUCTION : Angiomyxoma is a rare slow-growing soft tissue myxoid cell tumor that usually arises in the pelvis and perineal regions and occurs predominantly in women in the fourth decade. Angiomyxomas usually present as often initially misdiagnosed asymptomatic masses. Most common clinical early diagnoses of aggressive angiomyxomas are in form Of Vulvar Masses, Vulvar Lipomas, Bartholin's Cysts, Levator Hernias, Inguinal Hernias Or Cervical Polyps.This paper presents the case of the pelvic angiomyxoma diagnosis of a 41 year old with early findings of suspicious obturator hernia during the initial physical examination.The dissection was extended from the right retrorectal area to the ischiorectal cavity and the mass was reached. The capsulated mass of 10*15 cm with soft consistency was completely released and unblocked, it was excised from the abdomen through the incision using wound protection The obturator defect was repaired with interrupted sutures.Angiomyxoma is a rare, benign and locally aggressive tumor, which can infiltrate locally and present unusually as perineal hernia. Due to its rarity and lack of specific diagnostic requirements, it's difficult to diagnose preoperatively KEY WORDS: Angiomyxoma, Obturator hernia, Pelvic mass.L’angiomixoma è un raro tumore delle cellule mixoidi dei tessuti molli a crescita lenta che di solito si manifesta nella regione pelvica e perineale, prevalentemente in donne nel quarto decennio di vita. Gli angiomixomi di solito presentano masse asintomatiche spesso inizialmente esposte ad errori di diagnosi. Le diagnosi cliniche iniziali più comuni in caso di angiomixomi aggressivi sono sotto di masse vulvari, lipomi vulvari, cisti di Bartolino, ernie del muscolo levatore, ernie inguinali o polipi cervicali. Viene qui presentato il caso di un angiomixoma pelvico di un uomo di 41 anni con iniziale sospetto di ernia otturatoria durante l’esame fisico iniziale. La dissezione chirurgica è stata estesa dall’area retrorettale destra alla cavità ischiorettale e la massa è stata individuata. Si trattava di una massa capsulata di 10 x 15 cm con consistenza morbida, che è stata completamente liberata ed asportata dall’addome attraverso l’incisione facendo attenzione alla protezione della ferita. Il difetto dell’otturatore è stato riparato con suture a punti staccati. L’angiomixoma è un tumore raro, benigno ma localmente aggressivo, che può infiltrarsi localmente e presentarsi insolitamente come ernia perineale. A causa della sua rarità e della mancanza di requisiti diagnostici specifici, è difficile diagnosticare prima dell’intervento. more...
- Published
- 2019
36. Laparoscopic mesh repair of obturator hernia causing small bowel obstruction
- Author
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S Loizides and J Read
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medicine.medical_specialty ,Mesh repair ,business.industry ,Hernia, Obturator ,General Medicine ,Surgical Mesh ,medicine.disease ,Surgery ,Bowel obstruction ,Surgical mesh ,Intestine, Small ,Medicine ,Humans ,Hernia ,Intestinal obstruction surgery ,Laparoscopy ,Obturator hernia ,business ,Herniorrhaphy ,Intestinal Obstruction ,Technical Section - Published
- 2019
37. Role of the signs of obturator hernia in clinical practice: Author's reply
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Konstantinos Apostolou and Dimitrios Schizas
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medicine.medical_specialty ,business.industry ,Hernia, Obturator ,medicine.disease ,Surgery ,Clinical Practice ,medicine ,Humans ,Obturator hernia ,Tomography, X-Ray Computed ,business ,Herniorrhaphy ,Intestinal Obstruction ,Abdominal surgery - Published
- 2020
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38. Laparoscopic Mesh Repair of Bilateral Obturator Hernias Post-Peritoneal Dialysis
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Tracy M. Scott, Daphne Lu, and Jonathan Ramkumar
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medicine.medical_specialty ,medicine.medical_treatment ,Hernia, Inguinal ,030230 surgery ,Abdominal wall ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,medicine ,Humans ,Hernia ,Obturator hernia ,Herniorrhaphy ,Aged, 80 and over ,business.industry ,Hernia, Obturator ,General Medicine ,Surgical Mesh ,medicine.disease ,Femoral hernia ,Hernia repair ,digestive system diseases ,Hernia, Femoral ,Surgery ,stomatognathic diseases ,Inguinal hernia ,surgical procedures, operative ,medicine.anatomical_structure ,Obturator foramen ,Nephrology ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,business ,Tomography, X-Ray Computed ,Peritoneal Dialysis - Abstract
Abdominal wall hernias are prevalent in patients undergoing peritoneal dialysis (PD). Obturator hernias, first described by Arnaud de Ronsil in 1724, are an uncommon type of hernia where intra-abdominal contents protrude through the obturator foramen. The following case highlights a rare presentation of bilateral obturator hernias with right femoral and inguinal hernia in an 82-year-old woman post-PD. This patient presented with 5 months of bilateral thigh pain and swelling and was found to only have a right-sided obturator hernia on computer tomography (CT) scan. Intraoperatively, bilateral obturator hernias were found along with right inguinal and femoral hernias, which were all repaired laparoscopically with polypropylene mesh. Postoperatively, the patient developed a self-limiting port site hematoma and resumed PD 1 month post-surgery. Due to the high morbidity and mortality from obturator hernias, prompt diagnosis and treatment are imperative. Compared with open hernia repair, laparoscopic hernia repairs are associated with quicker return to usual activities and less persisting pain and numbness. This case portrays that laparoscopic approach to bilateral obturator hernias can be considered in patients post-PD. more...
- Published
- 2019
39. Radiographic and surgical findings of type I obturator hernias in patients with refractory groin pain
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Mark P. Zoland, Devon A. Klein, and Daniel D. Droukas
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Male ,medicine.medical_specialty ,Radiography ,Population ,Groin ,Pelvic Pain ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Hernia ,education ,Pelvis ,education.field_of_study ,business.industry ,Hernia, Obturator ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,stomatognathic diseases ,surgical procedures, operative ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Etiology ,Female ,Laparoscopy ,business ,Tomography, X-Ray Computed - Abstract
Groin pain is a common complaint in the general population, with an underlying etiology that may be difficult to diagnose. Although uncommon, type I obturator hernias may be a significant source of chronic or refractory groin pain. In this review, we discuss the commonly missed findings of type I obturator hernias at CT and MRI, as well as correlate these findings with images obtained at the time of laparoscopic repair. more...
- Published
- 2018
40. Obturator hernia and the elderly
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John D. Gilbert and Roger W. Byard
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medicine.medical_specialty ,Abdominal pain ,Cachexia ,Esophageal Neoplasms ,Autopsy ,Adenocarcinoma ,01 natural sciences ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Stomach Neoplasms ,Medicine ,Humans ,Hernia ,030216 legal & forensic medicine ,Obturator hernia ,Aged, 80 and over ,business.industry ,010401 analytical chemistry ,Hernia, Obturator ,Obturator canal ,Small Intestinal Obstruction ,General Medicine ,medicine.disease ,digestive system diseases ,0104 chemical sciences ,Surgery ,Bowel obstruction ,medicine.anatomical_structure ,Obturator foramen ,Female ,Esophagogastric Junction ,medicine.symptom ,business ,Pulmonary Embolism ,Intestinal Obstruction - Abstract
An 84-year-old woman with a history of weight loss, anorexia and episodic vomiting was admitted to hospital where she died soon afterwards. Her diagnosis was acute renal injury due to dehydration and malnutrition. At autopsy the body was cachectic with a small intestinal obstruction due to herniation through a defect at the anterolateral aspect of the obturator foramen. A poorly differentiated adenocarcinoma of the gastroesophageal junction was also identified with small peripheral pulmonary thromboemboli. Death was due to small bowel obstruction from a left obturator hernia with scattered peripheral pulmonary thromboemboli complicating cachexia due to gastroesophageal adenocarcinoma. Obturator hernias are called the "little old lady's hernia" and occur mainly in elderly, multiparous and malnourished women. The broader female pelvis and wider obturator canal with laxity of ligaments and loss of preperitoneal adipose tissue padding around the canal predispose to herniation. This rare hernia is often first identified at autopsy. more...
- Published
- 2018
41. Strangulated obturator hernia as an unusual cause of small bowel obstruction
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Mina Sarofim and Allan M. F. Kwok
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medicine.medical_specialty ,Groin ,Risk Assessment ,Severity of Illness Index ,03 medical and health sciences ,Fatal Outcome ,0302 clinical medicine ,Intestine, Small ,medicine ,Humans ,Obturator hernia ,Herniorrhaphy ,Aged, 80 and over ,Laparotomy ,business.industry ,Hernia, Obturator ,General Medicine ,medicine.disease ,Abdominal Pain ,Surgery ,Bowel obstruction ,030220 oncology & carcinogenesis ,Disease Progression ,Female ,Emergencies ,Tomography, X-Ray Computed ,business ,Intestinal Obstruction ,030217 neurology & neurosurgery - Published
- 2018
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42. Surgical Management of an Obturator Hernia
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Andrew, Mitchell, Daley S, Morera, and Steven, Holsten
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Aged, 80 and over ,Laparotomy ,Intestine, Small ,Hernia, Obturator ,Humans ,Female ,Tomography, X-Ray Computed ,Herniorrhaphy ,Intestinal Obstruction - Published
- 2018
43. Análisis de nuestra experiencia en el diagnóstico y tratamiento de la hernia obturatriz en un hospital de tercer nivel
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B Fernández-Velilla San José, A. Hernando Sanz, I Otegi Altolagirre, J Mateo Retuerta, A Goikoetxea Urdiain, P Sánchez-Acedo, and I Eguaras-Córdoba
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Perforation (oil well) ,Tertiary Care Centers ,Hernia obturatriz ,Laparotomy ,medicine ,Humans ,Hernia ,Obturator hernia ,Surgery mesh ,Prospective Studies ,Malla quirúrgica ,Clavien-Dindo ,Aged, 80 and over ,business.industry ,Hernia, Obturator ,Midline laparotomy ,General Medicine ,medicine.disease ,Surgery ,Polypropylene mesh ,Intestinal obstruction ,Intestinal occlusion ,Obstrucción Intestinal ,Female ,Intestinal resection ,business - Abstract
RESUMEN La patología herniaria supone un porcentaje importante de las intervenciones quirúrgicas urgentes. La hernia obturatriz es una entidad poco frecuente, presentándose generalmente como un cuadro de oclusión intestinal agudo en mujeres adultas. El objetivo del estudio es analizar la experiencia en un hospital de tercer nivel en el diagnóstico y tratamiento de la hernia obturatriz, así como detectar aquellos signos que permitan un diagnóstico precoz. La técnica de imagen de elección para su diagnóstico es la tomografía computarizada. Se trata de un estudio observacional prospectivo, en el que se incluyeron pacientes intervenidos de forma urgente por hernia obturatriz entre los años 2000 y 2016. Para el registro de la morbilidad postoperatoria se empleó la clasificación de Clavien-Dindo. Se identificaron doce pacientes con clínica de obstrucción intestinal secundaria a hernia obturatriz. Todos ellos fueron intervenidos de forma urgente, realizándose laparotomía media urgente en el 59%, laparotomía media infraumbilical en el 33% y abordaje por vía inguinal posterior en un solo paciente (8%). En ocho pacientes (67%) fue necesario realizar una resección intestinal por isquemia intestinal. La técnica quirúrgica empleada fue la reparación mediante malla de polipropileno en seis pacientes (50%), mediante tapón en dos (17%) y cierre con puntos sueltos en cuatro (33%). Cuatro de ellos presentaron complicaciones postoperatorias, registrando un único exitus secundario a perforación por sufrimiento intestinal. Es prioritario establecer un diagnóstico precoz y tratamiento quirúrgico urgente para reducir la morbimortalidad asociada a la hernia obturatriz. ABSTRACT Hernia pathology accounts for a large percentage of urgent surgical interventions. Obturator hernia is rare, usually presenting as a picture of acute intestinal occlusion. The aim of the study is to analyze the experience in a third level hospital in the diagnosis and treatment of obturator hernia, as well as to detect those signs that allow an early diagnosis. This is a prospective observational study, which included patients operated on urgently for obturator hernia between 2000 and 2016. For the registration of postoperative morbidity, the Clavien-Dindo classification was used. We identified twelve patients with intestinal obstruction secondary to obturator hernia. All of them were operated on urgently. Urgent midline laparotomy was carried out on 59% of them, infraumbilical laparotomy on 33%, and a posterior inguinal approach was realized on only one patient (8%). In eight patients (67%) it was necessary to perform intestinal resection. Repair was performed by polypropylene mesh in six patients (50%), by plugging in two (17%) and closing with loose stitches in four patients (33%). Four of them presented postoperative complications, recording a single exitus secondary to perforation due to intestinal suffering. Obturator hernia is a rare entity that develops mostly as an occlusive condition in elderly women. The imaging technique of choice for diagnosis is computed tomography. Establishing an early diagnosis and urgent surgical treatment is a priority to reduce associated morbidity and mortality. more...
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- 2018
44. Obturator Hernia: A Rare Cause of Small Bowel Obstruction
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Jian Guo, Long-Zhi Zheng, Si-Zeng Chen, and Wei Lin
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Aged, 80 and over ,medicine.medical_specialty ,Vomiting ,business.industry ,General surgery ,lcsh:R ,Hernia, Obturator ,lcsh:Medicine ,General Medicine ,medicine.disease ,Abdominal Pain ,Bowel obstruction ,Clinical Image ,Intestine, Small ,medicine ,Humans ,Female ,Intestinal obstruction surgery ,Hernia ,Obturator hernia ,Tomography, X-Ray Computed ,business ,Constipation ,Intestinal Obstruction - Published
- 2018
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45. How to do a uterine flap as a novel way to repair recurrent obstructed obturator hernia in an elderly female patient
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Peter J. Yuide, Geoff K. Muduioa, Peita M. Webb, and Tom J. De Greve
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medicine.medical_specialty ,Surgical Flaps ,03 medical and health sciences ,0302 clinical medicine ,Obstructed obturator hernia ,Recurrence ,Female patient ,medicine ,Humans ,Hernia ,Obturator hernia ,Aged ,business.industry ,Uterus ,Hernia, Obturator ,General Medicine ,Surgical procedures ,medicine.disease ,Surgery ,Surgical Procedures, Operative ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,business - Abstract
Here, we present a novel surgical technique to repair an obturator hernia with a uterine flap. The description is both written and in video format.
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- 2019
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46. Total extraperitoneal approach for incarcerated obturator hernia repair
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M. Kimura, R. Karashima, T. Nishimura, Y. Shimokawa, Hideo Baba, and N. Taura
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Laparotomy ,medicine ,Humans ,Obturator hernia ,Laparoscopy ,Herniorrhaphy ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,Groin ,business.industry ,Hernia, Obturator ,Femoral ring ,Hernia repair ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Obturator foramen ,030220 oncology & carcinogenesis ,Feasibility Studies ,Female ,030211 gastroenterology & hepatology ,business ,Intestinal Obstruction ,Abdominal surgery - Abstract
To compare the feasibilities and efficacies of the total extraperitoneal (TEP) technique and laparotomy for incarcerated obturator hernia repair. All study subjects were diagnosed with incarcerated obturator hernia, preoperatively and TEP was performed as for TEP groin hernia repair. The incarcerated intestine was retracted into the peritoneal cavity with the hernia sac. The obturator foramen was then covered with a rectangular mesh (9 × 13 cm), which also covered the internal inguinal ring, Hesselbach’s triangle, and the femoral ring. Non-ischemia of the incarcerated bowel was confirmed laparoscopically. In patients undergoing laparotomy, the obturator foramen was closed by continuous sutures, and no prosthesis was used. We recorded the length of hospital stay, operative time, amount of intraoperative bleeding, and postoperative complications. Twenty-two patients underwent obturator hernia repair in our hospital between January 2000 and December 2012, of whom 10 were treated with laparotomy and the remaining 12 via TEP. Three patients undergoing TEP were converted to laparotomy. The operation time was significantly longer in the conversion group compared with either the laparotomy or the TEP groups. There was no difference between the laparotomy and TEP groups regarding intraoperative bleeding. Patients who underwent TEP without conversion had a significantly shorter hospital stay than those who underwent laparotomy or required conversion. TEP provides a suitable approach for incarcerated obturator hernia repair, with favorable results regarding hospital stay. TEP is a feasible, minimally invasive technique for the repair of incarcerated obturator hernias. more...
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- 2015
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47. Incidental Non-Inguinals Hernias in Totally Extra-Peritoneal Hernia Repair
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KR Poskitt, O J Old, FJ Slim, SR Kulkarni, LG Emerson, Whyman, T J Hardy, and RA Bulbulia
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Hernia, Inguinal ,Cohort Studies ,Young Adult ,Sex Factors ,Recurrence ,Risk Factors ,medicine ,Humans ,Hernia ,Obturator hernia ,Aged ,Aged, 80 and over ,Incidental Findings ,Groin ,business.industry ,General surgery ,Age Factors ,Hernia, Obturator ,General Medicine ,Middle Aged ,medicine.disease ,Femoral hernia ,Hernia repair ,Hernia, Femoral ,Surgery ,stomatognathic diseases ,Inguinal hernia ,medicine.anatomical_structure ,General Surgery ,Cohort ,Female ,business ,Cohort study - Abstract
Introduction Totally extra-peritoneal (TEP) inguinal hernia repair allows identification and repair of incidental non-inguinal groin hernias. We assessed the prevalence of incidental hernias during TEP inguinal hernia repair and identified the risk factors for incidental hernias. Materials and Methods Consecutive patients undergoing TEP repair from May 2005 to November 2012 were the study cohort. Inspection for ipsilateral femoral, obturator and rarer varieties of hernia was undertaken during TEP repair. Patient characteristics and operative findings were recorded on a prospectively collected database. Results A total of 1,532 TEP repairs were undertaken in 1,196 patients. Ninety-three patients were excluded due to incomplete data, leaving 1,103 patients and 1,404 hernias for analyses (1,380 male; 802 unilateral and 301 bilateral repairs; median age, 59 years). Among the 37 incidental hernias identified (2.6% of cases), the most common type of incidental hernia was femoral (n=32, 2.3%) followed by obturator (n=2, 0.1%). Increasing age was associated with an increased risk of incidental hernia, with a significant linear trend (p60 years of age was 4.0% vs 1.4% for those aged Conclusions Incidental hernias during TEP inguinal hernia repair were found in 2.6% of cases and, though infrequent, could cause complications if left untreated. The risk of incidental hernia increased with age and was significantly higher in patients aged >60 years and in females. more...
- Published
- 2015
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48. Rare Case Of Bilateral Incarcerated Obturator Hernia: A Case Report
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Oktay Demirkiran, Metin Ertem, Sabri Erguney, Salih Pekmezci, Veysel Umman, Engin Hatipoğlu, Suleyman Demiryas, and Fatih Dal
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medicine.medical_specialty ,Peritonitis ,law.invention ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,law ,Rare case ,medicine ,Humans ,Obturator hernia ,Adverse effect ,Transabdominal preperitoneal ,Aged, 80 and over ,business.industry ,Hernia, Obturator ,Emergency department ,medicine.disease ,Intensive care unit ,Surgery ,Regimen ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Emergency Medicine ,Female ,030211 gastroenterology & hepatology ,Tomography, X-Ray Computed ,business ,Intestinal Obstruction - Abstract
Here, we report the case of an 84-year-old woman with acute mechanical intestinal obstruction (AMIO) who was admitted to our Emergency Department. Computed tomography (CT) scan revealed an incarcerated bilateral obturator hernia, and the defect was resolved using transabdominal preperitoneal (TAPP) technique with polypropylene mesh. The patient was administered an oral regimen two days after the operation. The patient stayed in the intensive care unit for 4 days and was uneventfully discharged on the 9th postoperative day. Follow-up was scheduled at the 6th month, during which no adverse events were detected and the patient did not report any complaints. Obturator hernia is among the differential diagnoses of intestinal obstruction requiring early diagnosis and prompt surgical intervention. Laparoscopic approach is less invasive compared with open surgery, and it can be attempted in cases presenting with no sign of ischemia or peritonitis. TAPP technique should be preferred since it allows the control of all intraabdominal pathologies and the viability of the intestines. more...
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- 2018
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49. Therapeutic Strategy for Incarcerated Obturator Hernia Using Preoperative Manual Reduction and Laparoscopic Repair
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Nobuhide Kubo, Takeshi Masuda, Toshifumi Matsumoto, Yushi Kaisyakuji, Shoji Hiroshige, Teijiro Hirashita, Hirofumi Kawanaka, Hirotada Tajiri, Tokujiro Yano, and Akinori Egashira
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Manual reduction ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Laparotomy ,Preoperative Care ,medicine ,Humans ,Hernia ,Obturator hernia ,Survival rate ,Herniorrhaphy ,Ultrasonography, Interventional ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Hernia, Obturator ,Retrospective cohort study ,Bowel resection ,Length of Stay ,Surgical Mesh ,medicine.disease ,Musculoskeletal Manipulations ,Surgery ,Survival Rate ,Surgical mesh ,Treatment Outcome ,030211 gastroenterology & hepatology ,Female ,Laparoscopy ,business - Abstract
Background Obturator hernia (OH) is a rare but serious disease associated with high morbidity and mortality due to advanced patient age and comorbidities. This study evaluated the feasibility of a laparoscopic approach to OH. Study Design We retrospectively reviewed the records of 32 patients (median age 84 years; 31 women) with OH treated between 2003 and 2016. Results Five patients with incidental OH underwent total extraperitoneal (TEP) repair. Of 27 patients with incarcerated OH, 18 patients underwent laparotomy, 13 of which required bowel resection, and the remaining 9 patients underwent preoperative ultrasound-guided manual OH reduction. Of 6 patients with successful OH release, 3 and 2 patients underwent TEP and transabdominal preperitoneal repair, respectively, and 1 patient declined the operation. Three patients with failure underwent laparoscopic exploration and conversion to open operation for bowel resection. Comparing the open and laparoscopic groups, the median operation times were 67.5 minutes vs 124 minutes, respectively (p = 0.004); median postoperative stay was 19 vs 11 days, respectively (p = 0.028); and Clavien-Dindo grade II or higher complications tended to be lower (28% vs 8%, respectively; p = 0.359). Even in patients without bowel resection, the median postoperative stay was significantly shorter in the laparoscopic group compared with the open group (7.5 vs 15 days, respectively; p = 0.032). During a mean follow-up of 24.5 months, the 3-year recurrence rate for OH was 25% for non-mesh repair and 0% for mesh repair (p = 0.335). Three- and 5-year cumulative survival rates were 83% and 71%, respectively. Conclusions Laparoscopic operations after ultrasound-guided manual reduction can be an alternative to emergent laparotomy in select OH patients. more...
- Published
- 2017
50. Efficacy of emergency exploratory laparotomy in incarcerated obturator hernia
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Tian-Chong Wu, Xiao-Hui Liang, and Qiao Lu
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medicine.medical_specialty ,China ,Exploratory laparotomy ,Abdominal Hernia ,medicine.medical_treatment ,Perforation (oil well) ,Operative Time ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Mass index ,Obturator hernia ,Herniorrhaphy ,Retrospective Studies ,Aged, 80 and over ,Laparotomy ,business.industry ,Mortality rate ,General surgery ,Abdominal Wall ,Hernia, Obturator ,Retrospective cohort study ,General Medicine ,Surgical Mesh ,medicine.disease ,Survival Rate ,030220 oncology & carcinogenesis ,Acute Disease ,Surgery ,Median body ,Female ,Emergencies ,business ,Tomography, X-Ray Computed - Abstract
Background: Incarcerated obturator hernia (IOH) is a scarce type of acute surgical disease, but the mortality rate is the highest in abdominal hernias. The aim of this study was to evaluate the efficacy of emergency exploratory laparotomy (EEL) in treating incarcerated obturator hernia (IOH).Methods: We conducted a retrospective study of 12 female patients with IOH underwent EEL between January 2014 and March 2016. The variables which included patient characteristics, findings of CT, operative time, postoperative complications, length of hospital stay, ICU admission rate, 30-day readmission rate and mortality were analyzed.Results: The age of patients was 82.5 ± 4.2 years and the median body mass index (BMI) was 20.6 kg/m2 (IQR, 18.7–21.5 kg/m2). There were 10 patients (83.3%) underwent partial intestinal resection due to partial small bowel necrosis or perforation. The total operation time was 85.7 ± 8.7 min. The time to initiation of a soft diet was 3.9 ± 0.7 days and the median length of stay w... more...
- Published
- 2017
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