Li Han, Cao Xuefeng, Kong Lingqun
Department of Hepatobiliary Surgery, Zibo Central Hospital, Zibo, China.
Binzhou Medical University, Binzhou, China.
Front Surg. 2023 Apr 25;10:1159246. doi: 10.3389/fsurg.2023.1159246. eCollection 2023.
Obturator hernia (OH) is a rare external abdominal hernia, accounting for only 0.07%-1% of all hernia cases. Because the female pelvis is wider and there is less preperitoneal adipose tissue, the obturator canal is larger, which can lead to herniation of abdominal contents when abdominal pressure increases in elderly women with thin body. The clinical symptoms of patients with obturator hernia included abdominal pain, nausea, vomiting, etc., and the mass in the inguinal region could not be touched. The positive Howship-Romberg sign is a specific sign of OH. CT is the first choice for the diagnosis of obturator hernia. Since intestinal incarceration in OH patients is prone to lead to intestinal necrosis, emergency surgical treatment is often required. However, due to the lack of specificity of its clinical manifestations, the misdiagnosis rate is high, which often leads to the delay of diagnosis and treatment.
We report the case of an 86-year-old woman with a thin body and a history of multiple deliveries. The patient presented with abdominal pain, bloating, and constipation for 5 days. Physical examination revealed a positive Howship-Romberg sign on the right side, and CT examination suggested intestinal obstruction. Therefore, an urgent exploratory laparotomy was performed.
After opening the abdominal cavity we found that the wall of the ileum was embedded in the right obturator, and the proximal bowel was significantly dilated. We restored the embedded bowel wall to its original position, resected the necrotic bowel and performed an end-to-end anastomosis of the small intestine. The right hernia orifice was sutured, and OH was diagnosed during the operation.
This article summarizes the diagnosis and treatment of OH by sharing this case, so as to provide a more detailed plan for early diagnosis and treatment of OH.
闭孔疝（OH）是一种罕见的腹外疝，仅占所有疝病例的0.07%-1%。由于女性骨盆较宽且腹膜前脂肪组织较少，闭孔管较大，这可能导致体型消瘦的老年女性在腹压增加时腹腔内容物疝出。闭孔疝患者的临床症状包括腹痛、恶心、呕吐等，腹股沟区无法触及肿块。霍希普-罗姆伯格征阳性是闭孔疝的特异性体征。CT是诊断闭孔疝的首选方法。由于闭孔疝患者肠道嵌顿易导致肠坏死，常需急诊手术治疗。然而，因其临床表现缺乏特异性，误诊率较高，常导致诊治延误。
我们报告一例86岁、体型消瘦且有多次分娩史的女性病例。患者出现腹痛、腹胀及便秘5天。体格检查右侧霍希普-罗姆伯格征阳性，CT检查提示肠梗阻。因此，行急诊剖腹探查术。
打开腹腔后我们发现回肠壁嵌顿于右侧闭孔，近端肠管明显扩张。我们将嵌顿的肠壁恢复原位，切除坏死肠段并进行小肠端端吻合。缝合右侧疝孔，术中诊断为闭孔疝。
本文通过分享该病例总结闭孔疝的诊断与治疗，以便为闭孔疝的早期诊断和治疗提供更详细的方案。
