An Interesting Case of Strangulate Left Obturator Hernia with Intestinal Obstruction and Septic Shock

Download Article

DOI: 10.21522/TIJPH.2013.SE.24.06.Art002

Authors : Sathish Kumar. G, Sarikaa Lakshmanan, Ritesh Rajmohan

Abstract:

Rare is the obturator hernia. It happens when the content of the pelvic cavity herniates through the obturator foramen. In the emergency room, it might be difficult to diagnose because the symptoms and signs are vague. It frequently affects old, malnourished, and sickly women. Intestinal obstruction accompanied by nausea, vomiting, and abdominal discomfort is the clinical presentation. Surgery is the gold standard of management. The high morbidity and mortality associated with this condition is due to its relatively late presentation because of its non-specific symptomatology. We report the case of an 82-year-old woman with a strangulated left obturator hernia with intestinal obstruction and septic shock. The hernia was diagnosed by an ultrasound of the abdomen which revealed evidence of free fluid in the peritoneal cavity with dilated fluid filled small bowel loops & left pelvic area showed small bowel loops located deep to the obturator muscles. Emergency laparotomy was performed by lower midline approach. We emphasize on the rule of ultrasound to establish a prompt preoperative diagnosis of a strangulated left obturator hernia, appropriate planning of surgical intervention and thus optimizing the outcome. This study aimed to present a case of strangulated left obturator hernia with intestinal obstruction and septic shock.

References:

[1].               Kisaoglu, A., Ozogul. B., Yuce, I., Bayramoglu, A., & Atamanalp, S. S., 2014, Obturator hernia, a rare cause of small bowel obstruction: Case report. The Eurasian Journal of Medicine, 46(3), 224. doi: 10.5152/eajm.2014.56.

[2].               Zhang, H., Cong, J. C., & Chen, C. S., 2010, Ileum perforation due to delayed operation in obturator hernia: A case report and review of literatures. World J Gastroenterol, 16(1), 126, doi: 10.3748/wjg.v16.i1.126.

[3].               Liao, C. F., Hsu, K. C., Liu, C. C., & Chuang, C. H., 2010, Obturator hernia: A diagnostic challenge of small-bowel obstruction. The American Journal of the Medical Sciences, 1, 339(1), 92-4, doi: 10.1097/MAJ.0b013e3181bc2129.

[4].                Uludag, M., Yetkin, G., Kebudi, A., Isgor, A., Akgun, I., & Dönmez, A. G. A., 2006, Rare cause of intestinal obstruction: Incarcerated femoral hernia, strangulated obturator hernia. Hernia, 10, 288-91, doi: 10.1007/s10029-006-0074-6.

[5].               Sorabella, R. A., Miniati, D. N., & Brandt, M. L., 2005, Laparoscopic obturator hernia repair in an adolescent. Journal of Pediatric Surgery, 1, 40(12), 39-41, doi: 10.1016/j.jpedsurg.2005.08.046.

[6].               Kohga, A., Kawabe, A., Cao, Y., Yajima, K., Okumura, T., Yamashita, K., Isogaki, J., & Suzuki, K., 2017, Elective laparoscopic repair after reduction might be useful strategy for incarcerated obturator hernia: A case report. Journal of Surgical Case Reports, 9, rjx180. doi: 10.1093/jscr/rjx180.

[7].               Shipkov, C. D., Uchikov, A. P., & Grigoriadis, E., 2004, The obturator hernia: Difficult to diagnose, easy to repair. Hernia, 8, 155-7, doi: 10.1007/s10029-003-0177-2.

[8].               Hayes, C., Schmidt, K., Neduchelyn, Y., & Ivanovski, I., 2020, Obturator hernia of Richter type: A diagnostic dilemma. BMJ Case Rep, 13(12), doi: 10.1136/bcr-2020-238252.

[9].               Gallegos, N. C., Dawson, J., Jarvis, M., & Hobsley, M., 1991, Risk of strangulation in groin hernias. Journal of British Surgery, 78(10), 1171-3, doi: 10.1002/bjs.1800781007.

[10].           Napa, M., Giridharan, B., Palit, S., Nikhithaa, P., Giridharan, S. B., & Palit, S. R., 2023, Strangulated sliding inguinoscrotal hernia with a gangrenous bladder and ileum. Cureus, 15(8), Doi 10.7759/cureus.43028.

[11].           Chung, C. C., Mok, C. O., Kwong, K. H., Ng, E. K., Lau, W. Y., & Li, A. K., 1997, Obturator hernia revisited: a review of 12 cases in 7 years. Journal of the Royal College of Surgeons of Edinburgh, 1, 42(2), 82-4.

[12].           Mantoo, S. K., Mak, K., Tan, T. J., 2009, Obturator hernia: Diagnosis and treatment in the modern era. Singapore Med J, 1, 50(9), 866-70.

[13].           Shapiro, K., Patel, S., Choy, C., Chaudry, G., Khalil, S., & Ferzli, G., 2004, Totally extraperitoneal repair of obturator hernia. Surg Endosc, 18, 954-956, doi: 10.1007/s00464-003-8212-z.

[14].           Kammori, M., Mafune, K., Hirashima, T., Kawahara, M., Hashimoto, M., Ogawa, T., Ohta, H., Hashimoto, H., & Kaminishi, M., 2004,  Forty-three cases of obturator hernia. Am J Surg, 187, 549-552, doi: 10.1016/j.amjsurg.2003.12.041.

[15].           Valente, T., Ferreira, N., Ferreira, G., Figueiredo, A., Bárbara, P., Marinho, R.,  & Santos, M. C., 2022, Little old lady’s hernia: A case of strangulated obturator hernia in a 88-year-old woman. International Surgery Journal, 9(12), 2045-2047. Doi: https://doi.org/10.18203/2349-2902.isj20223169.

[16].           Li, Z., Gu, C., Wei, M., Yuan, X., & Wang, Z., 2021, Diagnosis and treatment of obturator hernia: Retrospective analysis of 86 clinical cases at a single institution. BMC Surg, 21(1), 124.

[17].           Conti, L., Grassi, C., Banchini, F., Bonfili, D., Cattaneo, G. M., Baldini, E., & Capelli, P., 2022, Management of obturator hernia. Hernia Surgery, 93-106.

[18].           Mercado, M., Diab, J., & Loi, K., 2021, A delayed diagnosis of obturator hernia hoodwinked by previous laparoscopic inguinal hernia repair. J Surg Case Rep, 9, rjab407, doi: 10.1093/jscr/rjab407.

[19].           Meena, S. P., Vency, A. C., Badkur, M., & Lodha, M., 2021, Left Sided Strangulated Obturator Hernia: A Rare Case Report and Literature Review. Int J Appl Basic Med Res, 11(3), 198-200 doi: 10.4103/ijabmr.IJABMR_429_20.

[20].           Mnari, W., Hmida, B., Maatouk, M., Zrig, A., & Golli, M., 2019, Strangulated obturator hernia: a case report with literature review. Pan African Medical Journal, 26, 32(1), doi: 10.11604/pamj.2019.32.144.14846.

[21].           Nishina, M., Fujii, C., Ogino, R., Kobayashi, R., Kumada, K., Yamane, K., & Kohama, A., 2002, Preoperative diagnosis of obturator hernia by computed tomography. InSeminars in Ultrasound, CT and MRI, 23; 193-196. DOI: 10.1016/s0887-2171(02)90005-3.

[22].           Varghese, R. M., Subramanian, A. K., & Maliael, M. T., 2023, PowerScope™ for Class II Malocclusions: A Systematic Review and Meta-analysis. World Journal of Dentistry, 14(7), 639-647.

[23].           Rajamanickam, P., & Ramasamy, N., 2023, Effects of Ultrasonic Instrumentation on the Shear Bond Strength of Ceramic Brackets: An In Vitro Study. Journal of Advanced Oral Research, 14(1), 81-87. doi:10.1177/23202068231166507.

[24].           Krishnan, R. P., Pandiar, D., & Ramani, P., 2023, Sclerosing Variant of Adenoid Cystic Carcinoma - A Case Report on the Role of Sclerosis in the Prognostic Outcome. Annals of maxillofacial surgery, 13(2), 248–251. https://doi.org/10.4103/ams.ams_116_23.

[25].           Krishnan, R. P., Ramani, P., Gheena, S.,

[26].           Ramasubramanian, A., Karunagaran, M., & Hannah, R., 2022, Microscopic appearances of commonly implanted food particles. Journal of oral and maxillofacial pathology: JOMFP, 26(3), 352–355. https://doi.org/10.4103/jomfp.jomfp_117_21.

[27].           Jayaraman, S., Raj Natarajan, S., Ponnusamy, B., Veeraraghavan, V. P., & Jasmine, S., 2023, Unlocking the potential of beta sitosterol: Augmenting the suppression of oral cancer cells through extrinsic and intrinsic signalling mechanisms. The Saudi Dental Journal, 35(8), 1007–1013. https://doi.org/10.1016/j.sdentj.2023.08.003.

[28].           Pazhani, J., Jayaraman, S., Veeraraghavan, V. P., & Jasmine, S., 2024, Endothelin-1 axis as a therapeutic target in oral squamous cell carcinoma: Molecular insights. Journal of Stomatology, oral and Maxillofacial Surgery, 125(6), 101792. Advance online publication. https://doi.org/10.1016/j.jormas.2024.101792.

[29].           Jayaraman, S., Natarajan, S. R., Veeraraghavan, V. P., & Jasmine, S., 2023, Unveiling the anti-cancer mechanisms of calotropin: Insights into cell growth inhibition, cell cycle arrest, and metabolic regulation in human oral squamous carcinoma cells (HSC-3). Journal of Oral Biology and Craniofacial Research, 13(6), 704–713. https://doi.org/10.1016/j.jobcr.2023.09.002.

[30].           Gayathri, R., Ramani, P. and Veeraraghavan, V.P., 2024. Longitudinal study on salivary IL-6 trajectories in postoperative OSCC patients after chemotherapy and radiotherapy. Journal of Stomatology, Oral and Maxillofacial Surgery, p.101909. https://doi.org/10.1016/j.jormas.2024.101909.

[31].           JH, S.F., Jayaram, S., Veeraraghavan, V.P. and Karobar, M.I., 2024. miRNA99a as a Potential target in P13K/Akt1/mTOR signaling pathway in progression of OSCC. Advances in Biomarker Sciences and Technology, 6, pp.242-259. DOI: 10.1016/j.abst.2024.10.003.

[32].           Renu, K., 2024. A molecular viewpoint of the intricate relationships among HNSCC, HPV infections, and the oral microbiota dysbiosis. Journal of Stomatology, Oral and Maxillofacial Surgery, p.102134.

[33].           Kaarthikeyan, G., Jayakumar, N.D. and Sivakumar, D., 2019. Comparative Evaluation of Bone Formation between PRF and Blood Clot Alone as the Sole Sinus-Filling Material in Maxillary Sinus Augmentation with the Implant as a Tent Pole: A Randomized Split-Mouth Study. Journal of long-term effects of medical implants, 29(2).

[34].           Kavarthapu, A. and Malaiappan, S., 2019. Comparative evaluation of demineralized bone matrix and type II collagen membrane versus eggshell powder as a graft material and membrane in rat model. Indian Journal of Dental Research, 30(6), pp.877-880.

[35].           Manchery, N., John, J., Nagappan, N., Subbiah, G.K. and Premnath, P., 2019. Remineralization potential of dentifrice containing nanohydroxyapatite on artificial carious lesions of enamel: A comparative: in vitro: study. Dental research journal, 16(5), pp.310-317.