Abstract
Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women. Thirteen patients with obturator hernia were treated with surgery at Mitoyo General Hospital between 1992 and 2004. All were elderly females with a mean age of 83.8 years (range: 75-93 years) presenting with small bowel obstruction. The mean body mass index was 16.7 (range: 14.3-23.1) and the mean number of deliveries was 4.1 (range: 0-7). All 13 patients who underwent pelvic CT scanning received correct diagnoses preoperatively. The mean interval from admission to operation was 3.9 days (range: 0-10 days) and the gut resection rate was 69.2%. In one recent case, we performed laparoscopic surgery. The mean hospital stay was 49.1 days (range: 13-172 days) and all patients were cured and discharged. Of the 13 cases, we successfully performed the reduction of the incarcerated hernia with the water pressure method in the 6 most recent cases. In the water pressure method, a Nelaton catheter is inserted along the incarcerated small intestine into the hernia sac, saline is vigorously pumped into the sac, and the incarcerated small intestine is pushed out from the sac by the water pressure. In the 5 most recent cases, reverse and high ligation of the hernia sac was performed because infection of the sac was suspected. We recommend performing the reduction of an incarcerated hernia with the water pressure method, and the repair with reverse and high ligation of the hernia sac, since this procedure is more simple and useful in strangulated cases.
