Yaakoubi Jasser, Atallah Aziz, Guelbi Mohamed, Kamoun Mohamed Mehdi, Mestiri Hafedh, Omrani Sahir
Department of Surgery, Mongi Slim Hospital, Marsa, Tunisia.
Department of Surgery, Mongi Slim Hospital, Marsa, Tunisia.
Int J Surg Case Rep. 2025 Jun;131:111398. doi: 10.1016/j.ijscr.2025.111398. Epub 2025 May 1.
An obturator hernia is a rare condition representing less than 1 % of abdominal hernias and responsible for 0.05 to 1.4 % of cases of mechanical obstruction of the small intestine [1] typically affecting elderly, emaciated, multiparous women. Strangulation is a frequent complication and is generally the main clinical presentation. The positive diagnosis is often difficult because of the low specificity, hence the importance of sectional imaging. Surgical management must be initiated urgently to reduce the rate of morbidity and mortality.
A 79-year-old woman with a history of achalasia and esophageal squamous cell carcinoma undergoing radiotherapy presented with a five-day history of acute abdominal pain, vomiting, and abdominal distension. Clinical examination revealed diffuse tenderness with no palpable hernial orifices. Laboratory tests indicated an inflammatory response, and an abdominal CT scan demonstrated bowel distension with an ileal loop incarcerated in the right obturator foramen. Following brief resuscitation, she underwent midline laparotomy. Intraoperative findings confirmed a strangulated ileal loop with preserved vitality, along with an incidental left obturator hernia. Both obturator foramina were repaired using sutures and reinforcement with adjacent tissue.
The non-specific nature of symptoms often delays diagnosis, making CT imaging the gold standard for early detection. Prompt surgical intervention is vital to reduce the high morbidity and mortality associated with obturator hernias.
Although rare, obturator hernias require high clinical suspicion in high-risk populations. Early diagnosis through CT imaging and immediate surgical management are essential for improving patient outcomes and reducing complications.
闭孔疝是一种罕见疾病，占腹外疝的比例不到1%，在小肠机械性梗阻病例中占0.05%至1.4%[1]，通常影响老年、消瘦、经产妇。绞窄是常见并发症，通常也是主要临床表现。由于特异性低，阳性诊断往往困难，因此断层成像很重要。必须紧急进行手术治疗，以降低发病率和死亡率。
一名79岁女性，有贲门失弛缓症和食管鳞状细胞癌放疗史，出现急性腹痛、呕吐和腹胀5天。临床检查发现弥漫性压痛，未触及疝孔。实验室检查显示有炎症反应，腹部CT扫描显示肠扩张，一段回肠袢嵌顿于右闭孔内。经过短暂复苏后，她接受了中线剖腹手术。术中发现证实为绞窄性回肠袢，活力尚存，同时伴有偶然发现的左侧闭孔疝。两个闭孔均用缝线修补，并利用相邻组织加强。
症状的非特异性常导致诊断延迟，使CT成像成为早期检测的金标准。及时的手术干预对于降低与闭孔疝相关的高发病率和死亡率至关重要。
尽管罕见，但闭孔疝在高危人群中需要高度临床怀疑。通过CT成像早期诊断并立即进行手术治疗对于改善患者预后和减少并发症至关重要。
