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[Strangulated obturator hernia: a report of 17 cases]
S Hennekinne-Mucci1, P Pessaux, R Du Plessis
1Département de chirurgie viscérale, centre hospitalier universitaire Angers, 4, rue Larrey, 49100, Angers, France.
Purpose Of The Study:
To assess clinical, therapeutic and diagnostic findings of strangulated obturator hernias.
Patients And Method:
Retrospective study of 17 patients (16 women, 1 man; average age: 81.7 years), all treated in the same service, for strangulated obturator hernia. The studied criteria were: clinical characteristics (general status, obstruction, sign of Romberg-Howship), morphologic exams, mean delay for surgical treatment, and occurrence of postoperative complications.
Results:
The clinical examination revealed small bowel obstruction in 94% of the patients (n = 16) and incomplete obstruction in 1 patient; 23.5% of the patients presented a sign of Romberg-Howship. A major slimming was observed in 82% of the cases. A computed tomography, performed in 3 patients, showed the presence of air in the under-pubic channel. Preoperative diagnosis of obturator hernia was suspected in 23.5% of the cases. Surgical treatment was performed after a mean delay of 5.3 d. The mortality and morbidity rates were respectively 35 and 18%.
Conclusion:
Due to the low specificity of clinical examination, preoperative diagnosis of obturator hernia remains difficult. Computed tomography can be of great help for the diagnosis. Any therapeutic delay increasing mortality rate, surgery is mandatory in case of small bowel obstruction in order to make the diagnosis and the treatment of such rare pathology.