Mantoo S K, Mak K, Tan T J
Department of Surgery, Alexandra Hospital, 378 Alexandra Road, Singapore 159964.
Singapore Med J. 2009 Sep;50(9):866-70.
Obturator hernia is a rare variety of abdominal hernia that nonetheless is a significant cause of morbidity and mortality, especially in the elderly age group. This article aimed to review the diagnosis and management of obturator hernia by describing the anatomy, clinical presentation, predisposing factors, diagnostic modalities and management in the modern era.
We managed six cases of obturator hernia between 2003 and 2006. Five out of six cases were diagnosed by a preoperative computed tomography (CT) and the sixth case was diagnosed by ultrasonography. All except one were managed by an exploratory laparotomy and repair of the hernia, and one was treated with laparoscopic repair.
Correct preoperative diagnosis was made in five out of five (100 percent) patients by clinical signs and CT of the abdomen and pelvis, and the sixth patient was operated on the basis of an ultrasonographical diagnosis and strong clinical suspicion.
We conclude that the rapid evaluation by CT of the abdomen and pelvis and surgical intervention are possible, thereby reducing the morbidity and mortality of patients with obturator hernia. An algorithm for the management of obturator hernia is proposed.
闭孔疝是一种罕见的腹外疝，但却是发病和死亡的重要原因，尤其是在老年人群体中。本文旨在通过描述其解剖结构、临床表现、诱发因素、诊断方法及现代治疗手段，对闭孔疝的诊断和治疗进行综述。
我们在2003年至2006年间诊治了6例闭孔疝患者。6例中的5例通过术前计算机断层扫描（CT）确诊，第6例通过超声检查确诊。除1例采用腹腔镜修补术治疗外，其余均通过剖腹探查和疝修补术治疗。
5例（100%）患者通过腹部和盆腔的临床体征及CT检查获得了术前正确诊断，第6例患者基于超声诊断和强烈的临床怀疑接受了手术。
我们得出结论，通过腹部和盆腔CT快速评估并进行手术干预是可行的，从而降低闭孔疝患者的发病率和死亡率。本文提出了闭孔疝的治疗方案。
