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Hernia

, Volume 16, Issue 3, pp 315–319 | Cite as

Obturator hernia: the Mayo Clinic experience

  • B. S. Nasir
  • B. Zendejas
  • S. M. Ali
  • C. B. Groenewald
  • S. F. Heller
  • D. R. Farley
Original Article

Abstract

Background

Obturator herniae (OH) are rare, with nonspecific signs and symptoms, and diagnosis is usually delayed until laparotomy. The added benefit of preoperative diagnosis with computed tomography (CT) remains unclear.

Methods

We reviewed the clinical characteristics and outcomes of OH repairs performed at our institution over a 58-year period. Outcomes were compared between patients who did or did not have a preoperative CT.

Results

Between 1950 and 2008, 30 patients (median age 82 years, 29 women) underwent OH repair. The most common presenting signs and symptoms were bowel obstruction (63%), abdominal/groin pain (57%), and a palpable lump (10%). The pathognomonic Howship-Romberg sign was present in 11 patients (37%). The diagnosis was made preoperatively in nine patients: clinically in one (3%) and with CT in eight (27%). Nineteen patients (63%) presented emergently. Primary and prosthetic repair were performed in 23 (77%) and seven (23%) patients, respectively. Small-bowel resection was performed in 14 patients (47%). Perioperative morbidity (30%) and mortality (10%) rates were high. Patients with a preoperative CT were less likely to develop a postoperative complication of any type [odds ratio (OR) 0.8, P = 0.04]; however, time to operation, length of stay, need for bowel resection, and mortality rate did not differ (P = NS). No recurrences were detected at a median follow-up of 2 years (range 0–55).

Conclusion

Although CT imaging provides an excellent means of preoperative diagnosis, suggestive signs and symptoms in a “skinny old lady” should prompt immediate operative intervention without delay.

Keywords

Obturator hernia Computed tomography Mesh Recurrence Follow-up 

Notes

Acknowledgments

This publication was made possible by Grant Number 1 UL1 RR024150 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

References

  1. 1.
    Skandalakis LJ (2002) Obturator hernia, 5th edn. Lippincott Williams and Wilkins, New YorkGoogle Scholar
  2. 2.
    Yokoyama Y, Yamaguchi A, Isogai M, Hori A, Kaneoka Y (1999). Thirty-six cases of obturator hernia: does computed tomography contribute to postoperative outcome? World J Surg 23:214–216; discussion 7Google Scholar
  3. 3.
    Burt BM, Cevasco M, Smink DS (2010) Clinical images. Classic presentation of a type II obturator hernia. Am J Surg 199:75–76CrossRefGoogle Scholar
  4. 4.
    Losanoff JE, Richman BW, Jones JW (2002) Obturator hernia. J Am Coll Surg 194:657–663PubMedCrossRefGoogle Scholar
  5. 5.
    Shipkov CD, Uchikov AP, Grigoriadis E (2004) The obturator hernia: difficult to diagnose, easy to repair. Hernia 8:155–157PubMedCrossRefGoogle Scholar
  6. 6.
    Kammori M, Mafune K, Hirashima T (2004) Forty-three cases of obturator hernia. Am J Surg 187:549–552PubMedCrossRefGoogle Scholar
  7. 7.
    Rodriguez-Hermosa JI, Codina-Cazador A, Maroto-Genover A (2008) Obturator hernia: clinical analysis of 16 cases and algorithm for its diagnosis and treatment. Hernia 12:289–297PubMedCrossRefGoogle Scholar
  8. 8.
    Mantoo SK, Mak K, Tan TJ (2009) Obturator hernia: diagnosis and treatment in the modern era. Singapore Med J 50:866–870PubMedGoogle Scholar
  9. 9.
    Chang SS, Shan YS, Lin YJ, Tai YS, Lin PW (2005) A review of obturator hernia and a proposed algorithm for its diagnosis and treatment. World J Surg 29:450–454; discussion 4Google Scholar
  10. 10.
    Petrie A, Shane Tubbs R, Matusz P, Shaffer K, Loukas M (2011) Obturator hernia: anatomy, embryology, diagnosis, and treatment. Clin Anat. Epub 2011/02/16Google Scholar
  11. 11.
    Shapiro K, Patel S, Choy C, Chaudry G, Khalil S, Ferzli G (2004) Totally extraperitoneal repair of obturator hernia. Surg Endosc 18(6):954–956PubMedCrossRefGoogle Scholar
  12. 12.
    Bryant TL, Umstot RK Jr (1996) Laparoscopic repair of an incarcerated obturator hernia. Surg Endosc 10(4):437–438PubMedCrossRefGoogle Scholar
  13. 13.
    Chowbey PK, Bandyopadhyay SK, Khullar R et al (2004) Endoscopic totally extraperitoneal repair for occult bilateral obturator hernias and multiple groin hernias. J Laparoendosc Adv Surg Tech A 14(5):313–316PubMedCrossRefGoogle Scholar
  14. 14.
    Wu JM, Lin HF, Chen KH, Tseng LM, Huang SH (2006) Laparoscopic preperitoneal mesh repair of incarcerated obturator hernia and contralateral direct inguinal hernia. J Laparoendosc Adv Surg Tech A 16(6):616–619PubMedCrossRefGoogle Scholar
  15. 15.
    Cueto-García J, Rodríguez-Diaz M, Elizalde-Di Martino A, Weber-Sanchez A (1998) Incarcerated obturator hernia successfully treated by laparoscopy. Surg Laparosc Endosc 8(1):71–73PubMedCrossRefGoogle Scholar
  16. 16.
    Haith LR Jr, Simeone MR, Reilly KJ, Patton ML, Moss BE, Shotwell BA (1998) Obturator hernia: laparoscopic diagnosis and repair. JSLS 2(2):191–193PubMedGoogle Scholar
  17. 17.
    Yokoyama T, Munakata Y, Ogiwara M, Kawasaki S (1998) Laparoscopic mesh repair of a reducible obturator hernia using an extraperitoneal approach. Surg Laparosc Endosc 8(1):78–80PubMedCrossRefGoogle Scholar
  18. 18.
    Kim JJ, Jung H, Oh SJ et al (2005) Laparoscopic transabdominal preperitoneal hernioplasty of bilateral obturator hernia. Surg Laparosc Endosc Percutan Tech 15(2):106–109PubMedCrossRefGoogle Scholar
  19. 19.
    Hunt L, Morrison C, Lengyel J, Sagar P (2009) Laparoscopic management of an obstructed obturator hernia: should laparoscopic assessment be the default option? Hernia 13(3):313–315PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • B. S. Nasir
    • 1
  • B. Zendejas
    • 1
  • S. M. Ali
    • 1
  • C. B. Groenewald
    • 2
  • S. F. Heller
    • 1
  • D. R. Farley
    • 1
  1. 1.Department of SurgeryMayo ClinicRochesterUSA
  2. 2.Department of AnesthesiologyMayo ClinicRochesterUSA

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