Analysis of clinical diagnosis and treatment of obturator hernia: a report of 5 cases
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Department of Hepatopancreatobiliary Surgery & Hernia and Abdominal Wall Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, China

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R656.2

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    Abstract:

    Background and Aims Obturator hernia is a clinically rare external abdominal hernia, characterized by low preoperative diagnosis rate and high mortality rate. This article was conducted to analyze and summarize the etiology, clinical characteristics and diagnosis and treatment methods of obturator hernia by reviewing the treated cases with obturator hernia, so as to provide reference for diagnosis and treatment of this condition.Methods The clinical data of 5 cases of obturator hernia admitted to the Affiliated Hospital of Guangdong Medical University between January 2011 and January 2021 were retrospectively analyzed.Results Of the 5 cases of obturator hernia (involving 4 patients, in whom one female patient was diagnosed as left and right obturator hernia successively within half a year), one case was male and four cases were females; except for one case with a preoperative diagnosis of right inguinal hernia and an ipsilateral occult obturator hernia was found during operation, the other four cases were first diagnosed with acute mechanical intestinal obstruction. There were 3 cases of left obturator hernia and 2 cases of right obturator hernia; 3 cases underwent pelvic CT examination and obturator hernia was diagnosed before the operation, and 2 cases were identified during operation. Except one case underwent selective operation, the other cases underwent emergency laparotomy. There were 4 cases with small bowel incarceration, in whom one case underwent small bowel resection due to ischemic necrosis after incarceration, and the remaining 3 cases were reintroduced spontaneously or assisted by laparoscopy under intestinal anesthesia. In the repair method, 2 cases were closed by direct suture of obturator orifice with 3-0 Prolene, one case underwent open tension-free repair, and the other 2 cases underwent transabdominal preperitoneal approach (TAPP). After operation, one patient died in the ICU on the second day after surgery due to infectious shock, and the other 4 cases (3 patients) were cured and discharged. All cured patients were followed up after surgery. The follow-up time was 1 to 5 years, with a median time of (3.0±2.2) years. There was no recurrence of obturator hernia during the follow-up period.Conclusion The possibility of obturator hernia should be considered when elderly women have acute mechanical intestinal obstruction of unknown cause. The abdominopelvic CT examination is helpful for preoperative diagnosis. Surgery should be performed as soon as possible after definite diagnosis, and laparoscopic exploration and repair is recommended if the patients' condition allowed.

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YANG Yongguang, CHEN Weifeng, DENG Chunmei, CHEN Weice, ZHANG Yi, CHEN Ming, LIN Manzhou. Analysis of clinical diagnosis and treatment of obturator hernia: a report of 5 cases[J]. Chin J Gen Surg,2021,30(10):1197-1202.
DOI:10.7659/j. issn.1005-6947.2021.10.009

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History
  • Received:June 25,2021
  • Revised:September 17,2021
  • Adopted:
  • Online: November 02,2021
  • Published: