Urade Masaaki, Maruzen Shogo, Terakawa Hirofumi
General Surgery, Nanto Municipal Hospital, Nanto City, JPN.
Gastrointestinal Surgery/Breast Surgery, Kanazawa University, Kanazawa, JPN.
Cureus. 2024 Sep 22;16(9):e69917. doi: 10.7759/cureus.69917. eCollection 2024 Sep.
Obturator hernia is a rare condition. Preoperative diagnosis is difficult to achieve because the hernia swelling is rarely palpable. Diagnosis is often delayed, and the hernia can become fatal if intestinal strangulation occurs, especially in older patients. Hesitation in the intervention will result in perforation, peritonitis, sepsis, and death. We herein report a case involving a Japanese woman in her 90s who visited our emergency room with nausea and right inner thigh pain. Computed tomography (CT) at onset revealed intestinal incarceration between the piriformis and external obturator muscles; therefore, a right-sided obturator hernia was diagnosed. Manual release of the incarceration, combined with echo probe manipulation and lower extremity movement, was successfully performed. The patient's pain was dramatically reduced, and emergency surgery was avoided. A prompt hernia release after reaching the correct diagnosis is very important for obturator hernia patients. Scheduled minimally invasive surgery (transabdominal pre-peritoneal repair, TAPP) was subsequently performed. Intraoperatively, a coexistence of ipsilateral femoral hernia was detected by laparoscope. Therefore, we tried to cover not only the obturator canal but also the subclinical coexistence of ipsilateral groin hernias. All four hernia orifices (obturator hernia orifice, internal inguinal hernia orifice, external inguinal hernia orifice, and femoral hernia orifice) were covered at the same time with a single large mesh of 15 × 10 cm. Reports detailing such approaches (total and simultaneous coverage of the obturator canal and myopectineal orifice with one rectangular mesh) are relatively rare in the literature.
闭孔疝是一种罕见的病症。由于疝块很少能被触及，术前诊断很难实现。诊断常常延迟，如果发生肠绞窄，尤其是在老年患者中，疝可能会致命。干预的犹豫会导致穿孔、腹膜炎、败血症和死亡。我们在此报告一例涉及一名90多岁日本女性的病例，她因恶心和右大腿内侧疼痛前来我们的急诊室。发病时的计算机断层扫描（CT）显示梨状肌和闭孔外肌之间存在肠管嵌顿；因此，诊断为右侧闭孔疝。成功进行了手法松解嵌顿，并结合超声探头操作和下肢活动。患者的疼痛显著减轻，避免了急诊手术。对闭孔疝患者来说，在做出正确诊断后迅速进行疝松解非常重要。随后进行了预定的微创手术（经腹腹膜前修补术，TAPP）。术中，通过腹腔镜检测到同侧股疝并存。因此，我们不仅试图覆盖闭孔管，还试图覆盖同侧腹股沟疝的亚临床并存情况。用一块15×10厘米的大网片同时覆盖了所有四个疝孔（闭孔疝孔、腹股沟内疝孔、腹股沟外疝孔和股疝孔）。在文献中，详细描述这种方法（用一块矩形网片完全并同时覆盖闭孔管和肌耻骨孔）的报道相对较少。
