Chiba Yoshiyuki, Sugimoto Kiichi, Negami Naoki, Ishido Yasunori, Sugo Hiroyuki
Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, JPN.
Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, JPN.
Cureus. 2024 Nov 26;16(11):e74493. doi: 10.7759/cureus.74493. eCollection 2024 Nov.
An obturator hernia (OH) is a rare type of hernia that accounts for a very small proportion of all hernias and cases of small bowel obstruction. This condition predominantly affects older, underweight individuals, with the vast majority of patients being women. Laparotomy with simple suture closure of the defect is commonly used as surgical treatment for OH. However, the closeness of the obturator nerve to the obturator defect causes difficulty in observing this nerve due to the deep operative field in laparotomy. Thus, transabdominal pre-peritoneal hernia repair (TAPP) has advantages over an open approach, and TAPP is now commonly performed for OH. In the case described here, an 86-year-old female patient presented with lower abdominal pain and vomiting. Abdominal computed tomography revealed a right-sided OH causing intestinal obstruction, and the patient was referred to our hospital. Her medical history included hypertension, dementia, and an artificial head replacement for a left femoral neck fracture. Laboratory tests showed elevated white blood cell (WBC) of 13,700/μL, but other results were normal. Manual reduction of the hernia was successful, leading to symptom improvement, and the patient was admitted for observation. She was discharged on day three after admission. After one month, laparoscopic TAPP was performed. Bilateral OHs and femoral hernias were observed. Using a recently proposed 3D mesh inversion technique, the mesh was fitted anatomically for the OH. This is the first reported case of elective TAPP using a 3D MAXLight Mesh (Bard, Warwick, RI, US) with an inversion technique for bilateral OH and femoral hernia after incarcerated OH reduction.
闭孔疝（OH）是一种罕见的疝，在所有疝和小肠梗阻病例中占比极小。这种疾病主要影响老年、体重过轻的个体，绝大多数患者为女性。通过简单缝合缺损的剖腹手术通常用作OH的外科治疗方法。然而，由于剖腹手术的手术视野较深，闭孔神经与闭孔缺损距离较近，导致观察该神经存在困难。因此，经腹腹膜前疝修补术（TAPP）比开放手术具有优势，目前TAPP常用于治疗OH。在此描述的病例中，一名86岁女性患者出现下腹痛和呕吐。腹部计算机断层扫描显示右侧OH导致肠梗阻，该患者被转诊至我院。她的病史包括高血压、痴呆症以及因左股骨颈骨折进行的人工股骨头置换术。实验室检查显示白细胞（WBC）升高至13,700/μL，但其他结果正常。手法复位疝成功，症状得到改善，患者入院观察。入院三天后出院。一个月后，进行了腹腔镜TAPP。观察到双侧OH和股疝。使用最近提出的3D网片倒置技术，将网片按解剖结构适配于OH。这是第一例报道的在嵌顿性OH复位后，使用3D MAXLight网片（美国罗德岛沃里克市巴德公司）和倒置技术对双侧OH和股疝进行择期TAPP的病例。
