Resanovic Vladimir, Resanovic Aleksandar, Loncar Zlatibor
Vladimir Resanovic, MD, PhD, Assist Professor of Surgery, Medical Faculty, University of Belgrade; Clinic for Emergency Surgery, Emergency Center, University Clinical Center of Serbia, Belgrade, Serbia.
Aleksandar Resanovic, MD, PhD, General Surgeon, Dubai London Hospital, Dubai, UAE.
Pak J Med Sci. 2024 Dec;40(11):2755-2758. doi: 10.12669/pjms.40.11.9994.
Obturator hernia is a rare clinical condition, mainly affecting the elderly and frail patients. It is often challenging to diagnose, and carries a significant morbidity and mortality risk. We aim to highlight the importance of timely and adequate diagnosis followed by early intervention that can be done as open or laparoscopic. Furthermore, through a literature review, we intend to compare two types of surgical approaches (open vs. laparoscopic). Herein, we present the case of an 83 years old female admitted as an emergency with right lower quadrant, colicky abdominal pain, followed with nausea, vomiting and constipation. Computed Tomography (CT) scan revealed a right-sided incarcerated obturator hernia with proximal bowel distension. Emergency surgery was performed, emphasizing the importance of early intervention to prevent bowel necrosis and the need for bowel resection; due to asthma we opted for open approach. Intraoperatively, a right-sided incarcerated obturator hernia was confirmed, with a segment of small bowel herniating through the obturator canal. We discuss the role of CT scanning in diagnosis, the necessity of prompt surgical management, and the possibility of open and laparoscopic approaches through a literature review. The choice between open and laparoscopic approaches should be individualized, considering the patient's clinical status and the potential risks and benefits of each technique. Further research comparing the long-term results of open versus laparoscopic repair in incarcerated obturator hernia is something to be explored in the efforts of achieving the highest standards of patient care and maximizing the chances for an optimal treatment outcome.
闭孔疝是一种罕见的临床病症,主要影响老年体弱患者。其诊断往往具有挑战性,且具有较高的发病和死亡风险。我们旨在强调及时、充分诊断以及随后可采用开放或腹腔镜手术进行早期干预的重要性。此外,通过文献综述,我们打算比较两种手术方式(开放手术与腹腔镜手术)。在此,我们报告一例83岁女性因右下象限绞痛性腹痛急诊入院的病例,随后伴有恶心、呕吐和便秘。计算机断层扫描(CT)显示右侧嵌顿性闭孔疝伴近端肠管扩张。进行了急诊手术,强调了早期干预以预防肠坏死的重要性以及肠切除的必要性;由于患者患有哮喘,我们选择了开放手术方式。术中证实为右侧嵌顿性闭孔疝,一段小肠经闭孔管突出。我们通过文献综述讨论了CT扫描在诊断中的作用、及时手术治疗的必要性以及开放和腹腔镜手术方式的可能性。开放手术与腹腔镜手术方式的选择应个体化,考虑患者的临床状况以及每种技术的潜在风险和益处。比较嵌顿性闭孔疝开放手术与腹腔镜修补术长期结果的进一步研究,是在努力实现最高标准的患者护理和最大化获得最佳治疗结果机会方面有待探索的内容。