Forty-three cases of obturator hernia - 25/08/11

Doi : 10.1016/j.amjsurg.2003.12.041

Makoto Kammori, M.D., Ph.D. ^a,^b,^⁎ , Ken-ichi Mafune, M.D., Ph.D. ^a, Tokuji Hirashima, M.D. ^b, Masaki Kawahara, M.D., Ph.D. ^a, Masanori Hashimoto, M.D. ^a, Toshihisa Ogawa, M.D., Ph.D. ^a, Hideaki Ohta, M.D. ^c, Hajime Hashimoto, M.D., Ph.D. ^b, Michio Kaminishi, M.D., Ph.D. ^a
^a Division of Gastrointestinal Surgery and Metabolic and Endocrine Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
^b Department of Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
^c Department of Development Medicine, Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan

^*Corresponding author. Tel.: +81-3-3815-5411 ext. 35144; fax: +81-3-5800-9731

Abstract

Background

Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women. Because symptoms are nonspecific, the diagnosis is often delayed until laparotomy is performed form to treat bowel obstruction.

Methods

Forty-three patients with obturator hernia undergoing surgery at Tokyo Metropolitan Geriatric Hospital were divided retrospectively into two groups (group A = 23 patients from 1968 to 1986 before computed axial tomography [CAT] was developed; group B = 20 patients from 1987 to 1999 after CAT). Preoperative diagnosis, operative procedures, and postoperative course were reviewed and compared between the 2 groups.

Results

Preoperative diagnostic accuracy was significantly higher in group B at 80.0% (16 of 20 patients) than in group A at 43.5% (10 of 23 patients) (P = 0.0146). Rate of gut resection and mortality were significantly lower in group B at 25.0% (4 of 20) and 5.0% (1 of 20) than in group A at 52.2% (12 and 23) and 30.4% (7 of 23) (P = 0.0295 and P = 0.0385, respectively).

Conclusions

The use of pelvic CAT in cases of suspected obturator hernia significantly enhances preoperative diagnostic accuracy and helps to decrease both intestinal resection rate and surgical mortality.

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Keywords : Computed axial tomography, Intestinal obstruction, Obturator hernia