Total and Simultaneous Coverage Repair for the Obturator Hernia and Groin Hernias With One Large Mesh: A Case Report

Obturator hernia is a rare condition. Preoperative diagnosis is difficult to achieve because the hernia swelling is rarely palpable. Diagnosis is often delayed, and the hernia can become fatal if intestinal strangulation occurs, especially in older patients. Hesitation in the intervention will result in perforation, peritonitis, sepsis, and death. We herein report a case involving a Japanese woman in her 90s who visited our emergency room with nausea and right inner thigh pain. Computed tomography (CT) at onset revealed intestinal incarceration between the piriformis and external obturator muscles; therefore, a right-sided obturator hernia was diagnosed. Manual release of the incarceration, combined with echo probe manipulation and lower extremity movement, was successfully performed. The patient's pain was dramatically reduced, and emergency surgery was avoided. A prompt hernia release after reaching the correct diagnosis is very important for obturator hernia patients. Scheduled minimally invasive surgery (transabdominal pre-peritoneal repair, TAPP) was subsequently performed. Intraoperatively, a coexistence of ipsilateral femoral hernia was detected by laparoscope. Therefore, we tried to cover not only the obturator canal but also the subclinical coexistence of ipsilateral groin hernias. All four hernia orifices (obturator hernia orifice, internal inguinal hernia orifice, external inguinal hernia orifice, and femoral hernia orifice) were covered at the same time with a single large mesh of 15 × 10 cm. Reports detailing such approaches (total and simultaneous coverage of the obturator canal and myopectineal orifice with one rectangular mesh) are relatively rare in the literature.