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Obturator hernia: clinical analysis of 16 cases and algorithm for its diagnosis and treatment
J I Rodríguez-Hermosa1, A Codina-Cazador, A Maroto-Genover
1Department of General Surgery, Hospital Universitari Dr. Josep Trueta, Avda. de França, s/n, 17007 Girona, Spain. joserod@eresmas.net
Background:
Obturator hernia is an uncommon but important cause of intestinal obstruction.
Methods:
Retrospective study of 16 patients undergoing surgery for obturator hernia in a 20-year period.
Results:
All patients were elderly women. Low body mass index and multiparity were predisposing factors. Mean time from onset of symptoms to consultation was 4.1 days. The preoperative diagnosis was intestinal obstruction of unknown etiology in 13 cases and intestinal obstruction due to obturator hernia in three (diagnosis by CT). The rate of strangulated hernias was 75% and the perforation rate was 56.3%. Intestinal resection was required in 12 cases. Hernia repair was performed using polypropylene mesh in 11 cases and by means of simple suture and apposition of the peritoneum in five. Morbidity was 75% and mortality was 18.8%.
Conclusions:
Early diagnosis--we recommend CT in thin, elderly, multiparous women with intestinal obstruction--and early treatment can reduce complications and mortality.
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