Jayant Kumar, Agarwal Rajendra, Agarwal Swati
Pol Przegl Chir. 2015 Feb 3;86(10):490-2. doi: 10.2478/pjs-2014-0087.
Obturator hernia is a rare type of hernia which accounts for only 0.07-1.4% of all intra-abdominal hernias and 0.2-5.8% of small-intestinal obstructions. It develops predominantly in elderly underweight women. It has nonspecific early symptoms, so these hernias are usually discovered only after they have become incarcerated. Incarcerated obturator hernias are usually discovered on abdominal computed tomography scan or emergency surgery due to bowel obstruction. Here we present a case of a 65-year-old female who presented with intermittent abdominal pain, distension and nausea for last 3 days. She was a known case of hypothyroidism, taking Levothyroxine in inadequate dose. Her intial abdominal Xray was showing few air-fluid level with air present in rectum. She was initially managed conservatively but later developed features of peritonitis for which she was operated. In laparotomy, Richter type of right-sided incarcerated obturator hernia was discovered with a small necrotic area and perforation of small bowel. Bowel resection was performed and obturator hernia was closed with interrupted sutures. The patient recovered without complications. Obturator hernia, due to its rarity and nonspecific early symptoms, can still be misleading even to the most experienced clinicians. Delay in diagnosis of obturator hernia can lead to bowel necrosis and perforation with significant postoperative morbidity and mortality.
闭孔疝是一种罕见的疝，仅占所有腹内疝的0.07 - 1.4%，占小肠梗阻的0.2 - 5.8%。它主要发生在老年体重过轻的女性中。其早期症状不具特异性，所以这些疝通常在发生嵌顿后才被发现。嵌顿性闭孔疝通常在腹部计算机断层扫描或因肠梗阻进行急诊手术时被发现。在此，我们报告一例65岁女性病例，该患者在过去3天出现间歇性腹痛、腹胀和恶心。她是已知的甲状腺功能减退患者，服用左甲状腺素剂量不足。她最初的腹部X线显示少量气液平面，直肠内有气体。她最初接受保守治疗，但后来出现腹膜炎症状，为此接受了手术。在剖腹手术中，发现右侧嵌顿性闭孔疝为里氏型，伴有一小片坏死区域和小肠穿孔。进行了肠切除，并间断缝合关闭闭孔疝。患者康复，无并发症。由于闭孔疝罕见且早期症状不具特异性，即使对经验最丰富的临床医生也可能产生误导。闭孔疝诊断延迟可导致肠坏死和穿孔，术后发病率和死亡率显著增加。
