A Case of Impacted Obturator Hernia Treated by Elective Laparoscopic Repair After Manual Reduction / 日本農村医学会雑誌

ABSTRACT

An 86-year-old woman visited our hospital at 2000 with the chief complaint of right hip joint pain that had started at around 1930. The abdomen was soft and slightly bloated, and there was tenderness in the right hip joint. Computed tomography (CT) revealed protrusion of the small intestine through the right obturator foramen, and right-sided impacted obturator hernia was diagnosed. Intestinal necrosis was unlikely because her symptoms had started only a short time earlier, so manual reduction was performed. The right hip joint pain was rapidly alleviated, and CT confirmed release of the incarcerated bowel. Elective laparoscopic repair was then performed. Hemorrhagic ascites in the abdominal cavity, but no obvious intestinal ischemia, was evident. Intestinal dilation was relieved, enabling us to perform surgical maneuvers in a good surgical field. The postoperative course was favorable, and there has been no recurrence as of 2 years 11 months after surgery. Obturator hernia is common in elderly women, who often have several comorbidities. Avoidance of emergency surgery by manual reduction is therefore significant, and laparoscopic surgery that enables assessment and treatment of the contralateral side is beneficial.