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      Hernie obturatrice étranglée: à propos de deux cas Translated title: Strangulated obturator hernia: about two cases

      case-report

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          Abstract

          La hernie obturatrice (HO) est rare. Elle est à l'origine de 0,2 à 1,6% des occlusions mécaniques de l'intestin grêle avec un taux de mortalité et morbidité après chirurgie est respectivement de 35 et 18%. Nous rapportons le cas de deux patientes chez qui le diagnostic de HO étranglée est établie dans le cadre du bilan d'une occlusion. La HO est une entité dont le diagnostic préopératoire est difficile en raison de la faible spécificité clinique. L'examen tomodensitométrique semble être une aide majeure au diagnostic étiologique. Mais une fois le diagnostic d'occlusion posé, une intervention en urgence permettra d'en préciser l’étiologie et d'en réaliser le traitement. Tout retard thérapeutique majore la mortalité et la morbidité.

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          Obturator hernia: clinical analysis of 16 cases and algorithm for its diagnosis and treatment.

          Obturator hernia is an uncommon but important cause of intestinal obstruction. Retrospective study of 16 patients undergoing surgery for obturator hernia in a 20-year period. 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%. 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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            A review of obturator hernia and a proposed algorithm for its diagnosis and treatment.

            The aim of this article is to provide a review of six patients with the various stages of obturator hernia and a diagnostic and therapeutic strategy in suspected cases. Obturator hernia is relatively rare and is a diagnostic challenge. It is a significant cause of intestinal obstruction, especially in emaciated elderly women with chronic disease. A palpable groin mass is not common in these patients because the hernia mass is usually concealed beneath the pectineus muscle. The high mortality is directly related to the delayed recognition, with resultant ruptured gangrenous bowel, and to the high incidence of patients with concurrent medical illness. A total of six patients with obturator hernias were treated at this hospital between 1994 and 2004, and one of these patients was diagnosed and treated by elective laparoscopy. We reviewed these six cases and examined the clinical presentation, age, body weight, associated medical conditions, preoperative diagnosis, operative findings, complications, and outcome in this retrospective study. We concluded that we cannot shorten the time from onset of symptoms to admission, but what we can do is to make a rapid evaluation and surgical intervention to reduce the morbidity and mortality from obturator hernia. The approaches to different presentation of obturator hernia and diagnostic role of CT scan are also discussed.
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              Diagnosis and treatment of obturator hernia.

              Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n = 7) or an inguinal approach (n = 5). The hernial orifice was closed using the uterine fundus (n = 6), a patch (n = 5), and direct suture (n = 1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                24 February 2015
                2015
                : 20
                Affiliations
                [1 ]Service de Chirurgie B, CHU Hassan II, Fès, Maroc
                Author notes
                [& ]Corresponding author: Aggouri Younes, Service de Chirurgie B, CHU Hassan II, Fès, Maroc
                Article
                PAMJ-20-169
                10.11604/pamj.2015.20.169.3110
                4469444
                61a569df-da2c-4d39-b2db-8a23f8179b66
                © Aggouri Younes et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Case Report

                Medicine
                hernie obturatrice,occlusions,intestin grêle,obturator hernia,small intestine
                Medicine
                hernie obturatrice, occlusions, intestin grêle, obturator hernia, small intestine

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