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      Small bowel obstruction as a result of an obturator hernia: a rare cause and a challenging diagnosis

      case-report

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          Abstract

          Obturator hernias are exceedingly rare in surgical routine, constituting 0.073% of all intra-abdominal hernias in the West and 1% in the far East. Commonly known as ‘little old lady’s hernia’, obturator hernias are usually seen in frail, octogenarian multiparous women. This case report discusses an 85-year-old female who had symptoms of acute bowel obstruction; thanks to high degree of clinical suspicion and aided by a computed tomography (CT) of abdomen and pelvis, an incarcerated right obturator hernia was diagnosed preoperatively and treated successfully. Obturator hernia is a rare condition associated with a high rate of morbidity and mortality. CT scan is the most accurate imaging method for pre-operative diagnosis. Early diagnosis and surgical intervention are fundamentals to lead to better outcomes for the patients.

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          Most cited references8

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          Obturator hernia: the Mayo Clinic experience.

          Obturator herniae (OH) are rare, with nonspecific signs and symptoms, and diagnosis is usually delayed until laparotomy. The added benefit of preoperative diagnosis with computed tomography (CT) remains unclear. We reviewed the clinical characteristics and outcomes of OH repairs performed at our institution over a 58-year period. Outcomes were compared between patients who did or did not have a preoperative CT. Between 1950 and 2008, 30 patients (median age 82 years, 29 women) underwent OH repair. The most common presenting signs and symptoms were bowel obstruction (63%), abdominal/groin pain (57%), and a palpable lump (10%). The pathognomonic Howship-Romberg sign was present in 11 patients (37%). The diagnosis was made preoperatively in nine patients: clinically in one (3%) and with CT in eight (27%). Nineteen patients (63%) presented emergently. Primary and prosthetic repair were performed in 23 (77%) and seven (23%) patients, respectively. Small-bowel resection was performed in 14 patients (47%). Perioperative morbidity (30%) and mortality (10%) rates were high. Patients with a preoperative CT were less likely to develop a postoperative complication of any type [odds ratio (OR) 0.8, P = 0.04]; however, time to operation, length of stay, need for bowel resection, and mortality rate did not differ (P = NS). No recurrences were detected at a median follow-up of 2 years (range 0-55). Although CT imaging provides an excellent means of preoperative diagnosis, suggestive signs and symptoms in a "skinny old lady" should prompt immediate operative intervention without delay.
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            Surgical morbidity and mortality in obturator hernia: a 10-year retrospective risk factor evaluation.

            Obturator hernia is a rare condition occurring predominantly in elderly, thin, female patients and causes significant morbidity and mortality. Due to obscure presenting symptoms and signs, diagnosis and management are often delayed. While previous studies have attributed the high mortality to the delay in diagnosis, current literature remains controversial about this issue. The aim of this study was to identify peri-operative risk factors associated with mortality in patients with obturator hernia at our hospital.
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              Two-stage laparoscopic treatment for strangulated inguinal, femoral and obturator hernias: totally extraperitoneal repair followed by intestinal resection assisted by intraperitoneal laparoscopic exploration.

              Total extraperitoneal preperitoneal (TEP) repair is widely used for inguinal, femoral, or obturator hernia treatment. However, mesh repair is not often used for strangulated hernia treatment if intestinal resection is required because of the risk of postoperative mesh infection. Complete mesh repair is required for hernia treatment to prevent postoperative recurrence, particularly in patients with femoral or obturator hernia.
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                Author and article information

                Journal
                J Surg Case Rep
                J Surg Case Rep
                jscr
                Journal of Surgical Case Reports
                Oxford University Press
                2042-8812
                July 2018
                03 July 2018
                03 July 2018
                : 2018
                : 7
                : rjy161
                Affiliations
                [1 ]Third Surgical Department, Aristotle University of Thessaloniki, Medical School, AHEPA University Hospital, Kyriakidi 1, Thessaloniki, Greece
                [2 ]Department of Radiology, Aristotle University of Thessaloniki, Medical School, AHEPA University Hospital, Kyriakidi 1, Thessaloniki, Greece
                Author notes
                Correspondence address. A Samothraki 23, 54248 Thessaloniki, Greece. Tel: +30-23-10-31-8307; E-mail: pavlidis.md@ 123456gmail.com
                Article
                rjy161
                10.1093/jscr/rjy161
                6030978
                922e84cf-943f-484e-9651-856002b1523b
                Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2018.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@ 123456oup.com

                History
                : 10 June 2018
                : 18 June 2018
                Page count
                Pages: 3
                Categories
                Case Report

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