Scientific paper
Forty-three cases of obturator hernia

https://doi.org/10.1016/j.amjsurg.2003.12.041Get rights and content

Abstract

Background

Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women. Because symptoms are nonspecific, the diagnosis is often delayed until laparotomy is performed form to treat bowel obstruction.

Methods

Forty-three patients with obturator hernia undergoing surgery at Tokyo Metropolitan Geriatric Hospital were divided retrospectively into two groups (group A = 23 patients from 1968 to 1986 before computed axial tomography [CAT] was developed; group B = 20 patients from 1987 to 1999 after CAT). Preoperative diagnosis, operative procedures, and postoperative course were reviewed and compared between the 2 groups.

Results

Preoperative diagnostic accuracy was significantly higher in group B at 80.0% (16 of 20 patients) than in group A at 43.5% (10 of 23 patients) (P = 0.0146). Rate of gut resection and mortality were significantly lower in group B at 25.0% (4 of 20) and 5.0% (1 of 20) than in group A at 52.2% (12 and 23) and 30.4% (7 of 23) (P = 0.0295 and P = 0.0385, respectively).

Conclusions

The use of pelvic CAT in cases of suspected obturator hernia significantly enhances preoperative diagnostic accuracy and helps to decrease both intestinal resection rate and surgical mortality.

Section snippets

Methods

From 1968 to 1999, 43 cases of obturator hernias were diagnosed and treated at Tokyo Metropolitan Geriatric Hospital. All cases were reviewed retrospectively with respect to sex, age, body weight on admission, and pregnancy history. In 1987, CAT was introduced for the diagnosis of obturator hernias at our institute and was performed particularly in elderly and emaciated female patients who had intestinal obstruction.

To evaluate the effect of CAT, we divided 43 patients with obturator hernia

Patient characteristics and clinical symptoms

The 2 groups were comprised of 41 women and 2 men (female:male ratio 20.5:1). The patients ranged in age from 65 to 91 years (mean 80.2). Nine patients had a history of previous abdominal surgery (n = 4 in group A, n = 5 in group B), and 34 patients (81%) had no history of such surgery (n = 19 patients in group A, n = 15 in group B). There were no statistically significant differences between groups A and B regarding mean age (80.1 vs 80.3 years), body weight (34.2 vs 36.5 kg), number of

Comments

The total number of obturator hernias in this series represented 1.0% (43 of 4266) of all hernias repaired at our institution. Obturator hernia occurs in an older age group, and the mean age of patients in this series was 80.2 years. Multiparity and recent weight loss are important etiologic factor in the development of obturator hernia. Women are affected nine times more frequently than men because of their broader pelvis, larger obturator canal, and history of pregnancy [5], [6], [7]. In our

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    They constitute about 1% of all abdominal wall hernias, and account for about 1.6% of all cases of small bowel obstruction (5). The largest reported case series of obturator hernia constituted only 43 patients (6). These hernias are six times more likely to occur in elderly thin women in their 7th and 8th decades.

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