BACKGROUND: Obturator herniae (OH) are rare, with nonspecific signs and symptoms, and diagnosis is usually delayed until laparotomy. The added benefit of preoperative diagnosis with computed tomography (CT) remains unclear. METHODS: We reviewed the clinical characteristics and outcomes of OH repairs performed at our institution over a 58-year period. Outcomes were compared between patients who did or did not have a preoperative CT. RESULTS: Between 1950 and 2008, 30 patients (median age 82 years, 29 women) underwent OH repair. The most common presenting signs and symptoms were bowel obstruction (63%), abdominal/groin pain (57%), and a palpable lump (10%). The pathognomonic Howship-Romberg sign was present in 11 patients (37%). The diagnosis was made preoperatively in nine patients: clinically in one (3%) and with CT in eight (27%). Nineteen patients (63%) presented emergently. Primary and prosthetic repair were performed in 23 (77%) and seven (23%) patients, respectively. Small-bowel resection was performed in 14 patients (47%). Perioperative morbidity (30%) and mortality (10%) rates were high. Patients with a preoperative CT were less likely to develop a postoperative complication of any type [odds ratio (OR) 0.8, P = 0.04]; however, time to operation, length of stay, need for bowel resection, and mortality rate did not differ (P = NS). No recurrences were detected at a median follow-up of 2 years (range 0-55). CONCLUSION: Although CT imaging provides an excellent means of preoperative diagnosis, suggestive signs and symptoms in a "skinny old lady" should prompt immediate operative intervention without delay.
BACKGROUND: Obturator herniae (OH) are rare, with nonspecific signs and symptoms, and diagnosis is usually delayed until laparotomy. The added benefit of preoperative diagnosis with computed tomography (CT) remains unclear. METHODS: We reviewed the clinical characteristics and outcomes of OH repairs performed at our institution over a 58-year period. Outcomes were compared between patients who did or did not have a preoperative CT. RESULTS: Between 1950 and 2008, 30 patients (median age 82 years, 29 women) underwent OH repair. The most common presenting signs and symptoms were bowel obstruction (63%), abdominal/groin pain (57%), and a palpable lump (10%). The pathognomonic Howship-Romberg sign was present in 11 patients (37%). The diagnosis was made preoperatively in nine patients: clinically in one (3%) and with CT in eight (27%). Nineteen patients (63%) presented emergently. Primary and prosthetic repair were performed in 23 (77%) and seven (23%) patients, respectively. Small-bowel resection was performed in 14 patients (47%). Perioperative morbidity (30%) and mortality (10%) rates were high. Patients with a preoperative CT were less likely to develop a postoperative complication of any type [odds ratio (OR) 0.8, P = 0.04]; however, time to operation, length of stay, need for bowel resection, and mortality rate did not differ (P = NS). No recurrences were detected at a median follow-up of 2 years (range 0-55). CONCLUSION: Although CT imaging provides an excellent means of preoperative diagnosis, suggestive signs and symptoms in a "skinny old lady" should prompt immediate operative intervention without delay.
Authors: J I Rodríguez-Hermosa; A Codina-Cazador; A Maroto-Genover; J Puig-Alcántara; J M Sirvent-Calvera; E Garsot-Savall; J Roig-García Journal: Hernia Date: 2008-01-11 Impact factor: 4.739
Authors: D Schizas; K Apostolou; N Hasemaki; P Kanavidis; D Tsapralis; N Garmpis; C Damaskos; A Alexandrou; D Filippou; K Kontzoglou Journal: Hernia Date: 2020-08-09 Impact factor: 4.739