A Case of Repeated Incarcerated Bilateral Obturator Hernia Repaired Electively Using the Laparoscopic Total Extraperitoneal Approach After Noninvasive Reduction

Abstract

Three years ago, an 88-year-old woman presented to our emergency room with abdominal pain and was diagnosed as having an incarcerated left obturator hernia. Since reduction occurred spontaneously, elective surgery was planned, however, as the patient did not wish to undergo surgery, he was kept under observation. Subsequently, the patient was transported to other hospitals three times due to incarcerated obturator hernia, and the hernia was successfully reduced all the three times. Then, the patient was brought to our emergency room again with a 3-hour history of right lower abdominal pain and was diagnosed again as having an incarcerated right obturator hernia. We successfully performed manual reduction under ultrasound guidance. Thereafter, after evaluating the patient’s general condition, we performed laparoscopic totally extraperitoneal (TEP) repair electively for bilateral obturator hernias, and the patient was discharged from the hospital without any postoperative complications. Manual reduction of obturator hernias has become commonplace, and we have often encountered patients with repeated episodes of incarceration and reduction. In very elderly patients, we tend to be reluctant to perform surgery. It is important to bear in mind that incarceration could occur repeatedly even after reduction and to consider treatment strategies keeping this in mind, as in the case reported herein.