Two Cases of Obturator Hernia Incarceration Successfully Managed by Noninvasive Reduction Using the FROGS Method, Avoiding Emergency Surgery

Abstract

Case 1: An 88-year-old woman presented to the referring physician with a history of nausea and right lower abdominal pain. She was diagnosed by abdominal CT as having an incarcerated right obturator hernia and referred to our hospital. After noninvasive reduction using the FROGS method, we performed elective transabdominal preperitoneal hernia repair (TAPP), and the patient was discharged on postoperative day 3 without recurrence or pain. Case 2: A 101-year-old woman was brought to our emergency department with a history of left lower abdominal pain and vomiting. Abdominal CT revealed a left obturator hernia incarceration. Noninvasive reduction using the FROGS method was successfully performed; however, due to significant comorbidities, the patient was deemed unfit for surgery and continued to be managed conservatively. Although she did not develop recurrence of the obturator hernia, she died three months later of aspiration pneumonia. Non-invasive reduction for incarcerated obturator hernia is a valuable technique that may help to avoid emergency surgery and reduce the incidence of perioperative complications and mortality. Furthermore, in patients who are poor surgical candidates, although palliative in nature, repeated reductions of the hernia could enable avoidance of surgery. Therefore, we believe that surgeons should receive training in the use of this technique.