Site Overlay

Obturator hernia cause of ileus – modern diagnosis and surgical approach

By Boris

Volume 10, Issue 2

Original Article / Published: November 2022

DOI: https://www.doi.org/10.57045/jemis/1021122.pp78-88

V. Ivanov1, S. Marvakov1, V. Dimov2, I. Ivanov1, S. Strashilov3, R. Baikushev4, N. Vladov1

1Department of HPB and Liver Transplant Surgery, Military Medical Academy, Sofia, Bulgaria

2Department of Anesthesiology and Intensive Care, Military Medical Academy, Sofia, Bulgaria

3Department of Reconstructive and aesthetic surgery, UMBAL “Dr. Georgi Stranski”, Medical University, Pleven, Bulgaria

4Department of Radiology, Military Medical Academy, Sofia, Bulgaria

Abstract

Introduction: The obturator hernia (OH), which is considered relatively rare, is actually the most common of all hernias types of the pelvic floor. It represents 0.073% of all external hernias. Frequency is greater in older women between the 7th and 9th decades. The male: female ratio is 1:6. It mainly presents with symptoms of small bowel obstruction and accounts for 0.2-1.6% of all causes of ileus. Other concomitant complaints are pain in the thigh radiating to the knee (a symptom of Howship-Romberg) or swelling in the inguinal region with abdominal pain.

Case Report: We present an 83 -year -old woman who was admitted to the Surgery department of the Military Medical Academy – Sofia with complaints of abdominal pain, vomiting and stop of defecation for several days. From the tests done, ileus of small intestinal origin was established. The diagnosis of incarcerated, obturator hernia was made after a contrast-enhanced CT scan of the abdomen and pelvis. The patient underwent emergency surgery, during which the incarcerated, small intestinal loop was released, retrograde debarasage of the small intestine and plastic of the obturator channel with its own tissues was done.

Conclusions: Small bowel obstruction caused by incarceration in obturator hernia is one of the rare causes of intestinal obstruction in surgery, but on the other hand is a common manifestation in this type of hernia and one of the main causes of its detection. The combination of operative technique for the treatment of ileus condition and the plastic of the obturator channel produces good postoperative results.

References

  1. Kjossev KT, Losanoff JE. Gangrenous appendicitis in a strangulated obturator hernia. South Med J. 2003 Oct;96(10):1042-3. doi: 10.1097/01.SMJ.0000054691.62747.37.
  2. Rito CTC, Travassos J, Patrà Cio J, Duarte AL. Obturator hernia: a rare cause of bowel obstruction. BMJ Case Rep. 2017 Jul 28;2017:bcr2017219369. doi: 10.1136/bcr-2017-219369.
  3. Leitch MK, Yunaev M. Difficult diagnosis: strangulated obturator hernia in an 88-year-old woman. BMJ Case Rep. 2016 Jun 29;2016:bcr2016215428. doi: 10.1136/bcr-2016-215428.
  4. Susmallian S, Ponomarenko O, Barnea R, Paran H. Obturator hernia as a frequent finding during laparoscopic pelvic exploration: A retrospective observational study. Medicine (Baltimore). 2016 Jul;95(27):e4102. doi: 10.1097/MD.0000000000004102.
  5. Losanoff JE, Richman BW, Jones JW. Obturator hernia. J Am Coll Surg. 2002 May;194(5):657-63. doi: 10.1016/s1072-7515(02)01137-7.
  6. Tchupetlowsky S, Losanoff J, Kjossev K. Bilateral obturator hernia: a new technique and a new prosthetic material for repair–case report and review of the literature. Surgery. 1995 Jan;117(1):109-12. doi: 10.1016/s0039-6060(05)80237-5.
  7. Munoz-Forner E, Garcia-Botello S, Lopez-Mozos F, Marti-Obiol R, Martinez-Lloret A, Lledó S. Computed tomographic diagnosis of obturator hernia and its surgical management: a case series. Int J Surg. 2007 Jun;5(3):139-42. doi: 10.1016/j.ijsu.2006.10.001.
  8. Skandalakis LJ, Androulakis J, Colborn GL, Skandalakis JE. Obturator hernia. Embryology, anatomy, and surgical applications. Surg Clin North Am. 2000 Feb;80(1):71-84. doi: 10.1016/s0039-6109(05)70398-4.
  9. Watson LF. Hernia. Anatomy, etiology, symptoms, diagnosis,differential diagnosis, prognosis, and treatment. 3rd ed. St Louis:CV Mosby; 1948:457–475.
  10. Tornetta P 3rd, Hochwald N, Levine R. Corona mortis. Incidence and location. Clin Orthop Relat Res. 1996 Aug;(329):97-101.
  11. Berberoğlu M, Uz A, Ozmen MM, Bozkurt MC, Erkuran C, Taner S, Tekin A, Tekdemir I. Corona mortis: an anatomic study in seven cadavers and an endoscopic study in 28 patients. Surg Endosc. 2001 Jan;15(1):72-5. doi: 10.1007/s004640000194. Erratum in: Surg Endosc. 2004 Sep;18(9):1402. Bozkurt, C [corrected to Bozkurt, MC].
  12. Cali RL, Pitsch RM, Blatchford GJ, Thorson A, Christensen MA. Rare pelvic floor hernias. Report of a case and review of the literature. Dis Colon Rectum. 1992 Jun;35(6):604-12. doi: 10.1007/BF02050544.
  13. Hsu CH, Wang CC, Jeng LB, Chen MF. Obturator hernia: a report of eight cases. Am Surg. 1993 Nov;59(11):709-11.
  14. Yokoyama Y, Yamaguchi A, Isogai M, Hori A, Kaneoka Y. Thirty-six cases of obturator hernia: does computed tomography contribute to postoperative outcome? World J Surg. 1999 Feb;23(2):214-6; discussion 217. doi: 10.1007/pl00013176.
  15. Veeckmans G, Hermans P, Wyffels G, Hubens A. CT-scan diagnosis of bilateral obturator hernias in a patient with chronic chylous ascites. Hepatogastroenterology. 1993 Apr;40(2):131-3.
  16. Klinge U, Zheng H, Si ZY, Schumpelick V, Bhardwaj R, Klosterhalfen B. Synthesis of type I and III collagen, expression of fibronectin and matrix metalloproteinases-1 and -13 in hernial sac of patients with inguinal hernia. Int J Surg Investig. 1999;1(3):219-27.
  17. Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B. Abnormal collagen I to III distribution in the skin of patients with incisional hernia. Eur Surg Res. 2000;32(1):43-8. doi: 10.1159/000008740.
  18. Rischbieth H. A case of multiple herniae, obturator, ischiadic and femoral, in an adult. Aust Med Gaz 1913;34:71–74.
  19. Yip AW, AhChong AK, Lam KH. Obturator hernia: a continuing diagnostic challenge. Surgery. 1993 Mar;113(3):266-9.
  20. Yokoyama T, Munakata Y, Ogiwara M, Kamijima T, Kitamura H, Kawasaki S. Preoperative diagnosis of strangulated obturator hernia using ultrasonography. Am J Surg. 1997 Jul;174(1):76-8. doi: 10.1016/S0002-9610(97)00025-1.
  21. Chung CC, Mok CO, Kwong KH, Ng EK, Lau WY, Li AK. Obturator hernia revisited: a review of 12 cases in 7 years. J R Coll Surg Edinb. 1997 Apr;42(2):82-4.
  22. Marchal T, Parent S, Turtuyaux JM, et al. Obturator hernias—report of seven cases. Hernia 1997;1:73–76.
  23. Devlin HB. Management of abdominal hernias. London: Butterworths;1988:149–153.
  24. Naude G, Bongard F. Obturator hernia is an unsuspected diagnosis. Am J Surg. 1997 Jul;174(1):72-5. doi: 10.1016/S0002-9610(97)00024-X.
  25. Rodríguez-Hermosa JI, Codina-Cazador A, Maroto-Genover A, Puig-Alcántara J, Sirvent-Calvera JM, Garsot-Savall E, Roig-García J. Obturator hernia: clinical analysis of 16 cases and algorithm for its diagnosis and treatment. Hernia. 2008 Jun;12(3):289-97. doi: 10.1007/s10029-007-0328-y.
  26. Ijiri R, Kanamaru H, Yokoyama H, Shirakawa M, Hashimoto H, Yoshino G. Obturator hernia: the usefulness of computed tomography in diagnosis. Surgery. 1996 Feb;119(2):137-40. doi: 10.1016/s0039-6060(96)80160-7.
  27. Meziane MA, Fishman EK, Siegelman SS. Computed tomographic diagnosis of obturator foramen hernia. Gastrointest Radiol. 1983;8(4):375-7. doi: 10.1007/BF01948155.
  28. Chu CW, Loftus WK, Somers SS, Metreweli C. Obturator hernia diagnosed by computed tomography. Aust N Z J Surg. 1997 Oct;67(10):737-8. doi: 10.1111/j.1445-2197.1997.tb07123.x.
  29. O’Connell G, Cole A. Obturator hernia: diagnosis through medical imaging. Australas Radiol. 1995 Aug;39(3):306-8. doi: 10.1111/j.1440-1673.1995.tb00300.x.
  30. van der Linden FM, Puylaert JB, De Vries BC. Ultrasound diagnosis of incarcerated obturator hernia. Eur J Surg. 1995 Jul;161(7):531-2.
  31. Schmidt PH, Bull WJ, Jeffery KM, Martindale RG. Typical versus atypical presentation of obturator hernia. Am Surg. 2001 Feb;67(2):191-5.
  32. Terada R, Ito S, Kidogawa H, Kashima K, Ooe H. Obturator hernia: the usefulness of emergent computed tomography for early diagnosis. J Emerg Med. 1999 Sep-Oct;17(5):883-6. doi: 10.1016/s0736-4679(99)00100-6.
  33. Tsutsui S, Kitamura M, Shirabe K, Yoshizawa S, Yoshida M. Radiographic diagnosis of obturator hernia. Br J Surg. 1994 Sep;81(9):1372. doi: 10.1002/bjs.1800810941.
  34. Jones RL, Wingate JP. Herniography in the investigation of groin pain in adults. Clin Radiol. 1998 Nov;53(11):805-8. doi: 10.1016/s0009-9260(98)80190-6.
  35. Tschudi J, Wagner M, Klaiber C. Laparoskopische Operation einer incarcerierten Obturatoriushernie mit assistierter Darmresektion [Laparoscopic operation of incarcerated obturator hernia with assisted intestinal resection]. Chirurg. 1993 Oct;64(10):827-8. German.
Volume 10, Issue 2
Article [pdf]

Keywords:

obturator hernia, small bowel obstruction, incarceration, obturator channel reconstruction

How to cite this article:

Ivanov V, Marvakov S, Dimov V, Ivanov I, Strashilov S, Baikushev R, Vladov N. Obtator hernia cause of ileus  – modern diagnosis and surgical approach. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2022; 10(2): 78-88

Corresponding author:

Dr Veselin Ivanov 

Department of HPB and Liver Transplant Surgery
Military Medical Academy of Sofia

3 “Georgi Sofiiski” blvd.
Sofia 1606, Bulgaria

E-mail: vesdimitrovbg@gmail.com; Tel: +359878554988 Web: www.urology-vma.bg