Diagnosis And Treatment Of Obturator Hernia

ObjectiveObturator hernia(OH)is rare in clinical practice,which is caused by obturator tube protrusion formed by tissue or abdominal viscera through ischial branch and pubic bone.The clinical diagnosis of obturator hernia is difficult.Different from other abdominal wall hernias with specific clinical manifestations,patients are often admitted to the emergency department with symptoms of acute intestinal obstruction of unknown causes.Clinically,the diagnosis of OH is not clear in time,resulting in poor prognosis.In this paper,the clinical characteristics,diagnosis and treatment of OH were analyzed and discussed in combination with the data of OH treated and operated.MethodsFrom February 2014 to October 2022,a total of 16 patients with OH were admitted to the Affiliated Hospital of Yangzhou University and confirmed by surgery.The clinical data of the patients were collected by the inpatient case system.EXCEL2022 and SPSS26.0 were used to analyze the patient ’s gender,age,height,weight,number of births,clinical manifestations,surgical methods,preoperative and postoperative hernia location,postoperative complications,hospitalization time and other data.ResultsOf the 16 patients with OH admitted to our hospital,14 were female and the remaining 2 were male.The ratio of male to female was 1:7.The age of patients ranged from 42 to 95 years old,with a median age of(76.3 ± 13.9)years old.The body weight ranged from 32 to 78 kg,with an average weight of(47 ± 13.0)kg and a body mass index of(18.3 ± 3.9)kg / m2.Female patients had multiple births,with an average of(2± 1).Most of the patients had underlying diseases on admission,and most of them had respiratory diseases.Among the clinical manifestations,13 patients showed acute intestinal obstruction symptoms such as ’ pain,vomiting,distension and closure ’ on admission,accounting for 81 % of the total number of cases in this study.Seven patients had positive H-R sign,4 patients had palpable mass in the medial groin,and 4 patients had tenderness,rebound pain and muscle tension in the lower abdomen after admission.All the 16 patients underwent CT examination before operation,and 13 patients were diagnosed definitely,with a diagnosis rate of 81 %.All patients underwent surgical treatment,including 8 cases of traditional laparotomy + OH repair,and 8 cases of TAPP.There was no significant difference in operation time,complications and postoperative mortality between the traditional open surgery group and the laparoscopic surgery group(p > 0.05),but the statistical analysis of the amount of bleeding and hospitalization time p values were less than 0.005,the difference was statistically significant.The hernia contents of 13 cases were small intestine and 3 cases were preperitoneal adipose tissue.A total of 5 patients were found to have intestinal necrosis perforation,of which 3 underwent partial intestinal resection and intestinal anastomosis,and the remaining 2 underwent intestinal perforation repair.The interval from symptom onset to operation was(2.6 ± 1.7)d.There was no significant difference in the time from onset to operation,intestinal perforation or intestinal resection,postoperative complications and mortality(p > 0.05).In the repair method,9 patients underwent simple suture repair and 7 patients underwent patch repair.The patches were synthetic patches.The repair method had no statistical significance for intestinal perforation or intestinal resection,postoperative complications and mortality(p > 0.05).All patients underwent surgery successfully.The overall operation time was 40-160 min,with an average of(88.1 ± 36.0)min.The intraoperative blood loss ranged from 10 to 100 ml,with an average of(33.8 ± 26.1)ml.During hospitalization after operation,1 patient had incision infection,1 patient had pulmonary infection,and all recovered after symptomatic treatment.One patient died of multiple organ failure after being transferred to intensive care unit,and the remaining 13 patients were cured and discharged.The mean hospital stay was(10.6 ± 5.9)days(range,4-25days).All patients were followed up for(4-33)months,with an average of(16.3 ±12.0)months,and no hernia recurrence was found.ConclusionsOH is a rare clinical disease,and its clinical manifestations lack specificity.The possibility of OH should be considered if the elderly and frail multiparas have unexplained small bowel obstruction symptoms.Preoperative abdominal and pelvic CT examination is helpful for the early diagnosis of OH.Timely and accurate diagnosis is the basis for reducing the mortality of OH.Surgery should be carried out as soon as possible after the patient ’s diagnosis is clear.According to the specific conditions of the patient,if the conditions permit,it is recommended to give priority to laparoscopic exploration and repair.If there is no contraindication,a patch can be used to enhance the repair.