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Increased length of incarcerated small bowel as a risk factor for intestinal necrosis in obturator hernia
Yoshiyuki Kiyasu1,2, Naoki Oka3,4, Makio Mike3
1Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-Cho, Kamogawa, Chiba, 296-8602, Japan. ykiyasu@kuhp.kyoto-u.ac.jp.
Background:
Incarcerated obturator hernia (OH) is a rare type of pelvic wall hernia. With the increasing adoption of reduction techniques for incarcerated OH, it is crucial to assess the extent of damage to the incarcerated intestine. This study aimed to identify objective risk factors for intestinal necrosis based on computed tomography (CT) findings.
Methods:
From October 2004 to June 2013, data from consecutive patients diagnosed with incarcerated OH at Kameda Medical Center were collected. All patients underwent laparotomy and were classified into either the viable group (no incarceration-related intestinal damage) or the necrosis group (incarceration-related intestinal damage present). Patient characteristics and CT findings were retrieved retrospectively, including incarcerated intestine length, obturator canal width, and precise location of incarceration. Multivariate logistic regression with backward elimination was performed to identify risk factors for intestinal necrosis.
Results:
A total of 37 patients were included, with 25 in the viable group and 12 in the necrosis group. Multivariate analysis revealed that increased incarcerated intestine length on CT was significantly associated with necrosis (p = 0.004; odds ratio, 1.19 per 1-mm increase; 95% confidence interval, 1.06-1.34), outweighing other factors such as white blood cell count, C-reactive protein levels, and time from onset to hospital arrival.
Conclusion:
Length of the incarcerated small bowel on CT may be a potential risk factor for intestinal necrosis in patients with OH.
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