A rare cause of intestinal obstruction: obturator hernia

Abstract

Abstract

Obturator hernia is a rare pelvic hernia which represents 1% of all hernias. Obturator hernia, which is generally observed in elderly thin women having an accompanying disease, is diagnosed late since it has no specific symptoms and findings. For this reason, morbidity and mortality rates are high in obturator hernia. Of the patients with obturator hernia, 0.4% have mechanical intestinal obstruction. The most frequent finding of obturator hernia is intestinal obstruction with strangulation.  Treatment of obturator hernia is emergent surgery.  In this case report, we present an obturator hernia case having a positive Howship-Romberg sign and typical appearance in computerized tomography.

Keywords: Obturator hernia, intestinal obstruction, computerized tomography, Howship-Romberg sign

Özet

Obturator herni tüm hernilerin %1 kadarını oluşturan nadir bir durumdur. Çoğunlukla eşlik eden bir hastalığı olan yaşlı ve zayıf kadınlarda görülür. Spesifik belirti ve bulguları olmadığı için geç tanı konur ve mortalite ve morbidite yüksektir. Olguların %0,4’ünde mekanik intestinal obstrüksiyon gelişir. En sık bulgusu strangülasyon ile birlikte olan intestinal obstrüksiyondur. Tedavisi acil cerrahi olarak yapılır. Bu olgu sunumunda bilgisayarlı tomografi ile pozitif Howship-Romberg bulgusu ve atipik görüntü izlenen bir obturator herni olgusu irdelenmiştir.

Anahtar sözcükler: Obturator herni, intestinal obstrüksiyon, bilgisayarlı tomografi, Howship-Romberg bulgusu

Kaynakça

1. Ziegler DW, Rhoads JE Jr. Obturator hernia needs a laparotomy, not a diagnosis. Am J Surg. 1995 Jul;170(1):67-8.
2. 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.
3. Shapiro K, Patel S, Choy C, Chaudry G, Khalil S, Ferzli G. Totally extraperitoneal repair of obturator hernia. Surg Endosc. 2004 Jun;18(6):954-6.
4. Uludag M, Yetkin G, Kebudi A, Isgor A, Akgun I, Dönmez AG. A rare cause of intestinal obstruction: incarcerated femoral hernia, strangulated obturator hernia. Hernia. 2006 Jun;10(3):288-91.
5. Green BT. Strangulated obturator hernia: still deadly. South Med J. 2001 Jan;94(1):81-3.
6. Schmidt PH, Bull WJ, Jeffery KM, Martindale RG. Typical versus atypical presentation of obturator hernia. Am Surg. 2001 Feb;67(2):191-5.
7. Nasir BS, Zendejas B, Ali SM, Groenewald CB, Heller SF, Farley DR. Obturator hernia: the Mayo Clinic experience. Hernia. 2012 Jun;16(3):315-9. doi: 10.1007/s10029-011- 0895-9.
8. Cai X, Song X, Cai X. Strangulated intestinal obstruction secondary to a typical obturator hernia: a case report with literature review. Int J Med Sci. 2012;9(3):213-5. doi: 10.7150/ijms.3894.

9. Lo CY, Lorentz TG, Lau PW. Obturator hernia presenting as small bowel obstruction. Am J Surg. 1994 Apr;167(4):396-8.
10. Mandarry MT, Zeng SB, Wei ZQ, Zhang C, Wang ZW. Obturator hernia-a condition seldom thought of and hence seldom sought. Int J Colorectal Dis. 2012 Feb;27(2):133- 41. doi: 10.1007/s00384-011-1289-2.
11. Hsu CH, Wang CC, Jeng LB, Chen MF. Obturator hernia: a report of eight cases. Am Surg. 1993 Nov;59(11):709-11.
12. Hannington-Kiff JG. Absent thigh adductor reflex in obturator hernia. Lancet. 1980 Jan 26;1(8161):180.
13. Kammori M, Mafune K, Hirashima T, Kawahara M, Hashimoto M, Ogawa T, Ohta H, Hashimoto H, Kaminishi M. Forty-three cases of obturator hernia. Am J Surg. 2004 Apr;187(4):549-52.
14. Karasaki T, Nakagawa T, Tanaka N. Obturator hernia: the relationship between anatomical classification and the Howship-Romberg sign. Hernia. 2014 Jun;18(3):413-6. doi: 10.1007/s10029-013-1068-9.
15. Rodríguez-Hermosa JI1, 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.
16. Leow JJ, How KY, Goh MH, Woon WW, Low JK. Non-operative management of obturator hernia in an elderly female. Hernia. 2014 Jun;18(3):431-3. doi: 10.1007/s10029-012-1036-9.