Preoperative evaluation of irreversible bowel ischemia in obturator hernia

Obturator hernia presenting in elderly women accompanies a high rate of bowel resection because of strangulation. Open laparotomy is usually indicated in general anesthesia. However, minimal invasive approaches would be advantageous unless resection is necessary. We aimed to determine clinical and radiological criteria for the selection of these patients.

Preoperative clinical data from 23 cases and known signs of ischemia on CT examination were retrospectively compared to operative findings.

Identification of patients having necrotic bowel was not possible by any clinical parameter or their combination. Patients with necrosis had longer history of symptoms, but acute onset less than 24 h does not exclude the need of resection (negative predictive value 83%). Impaired contrast enhancement was frequently seen on CTs independently from the onset of symptoms suggesting early vascular compromise (sensitivity 80%, specificity 22%), but not helping the differentiation. Signs of ischemia (bowel wall thickening and/or ascites) were present in every resected case while both were absent in 69% of patients having viable bowel.

Absence of ischemic signs on nonenhanced CT may allow safe and more accurate selection of patients for minimal invasive surgery than any clinical or anamnestic parameter in obturator hernia.