Special Consideration: The Obturator Hernia

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  • Female predominance likely a result of multiparity, wider pelvis, larger obturator rings. High mortality rate is a reflection of the typical patient- frail, emaciated, with multiple comorbidities
  • Female predominance likely a result of multiparity, wider pelvis, larger obturator rings. High mortality rate is a reflection of the typical patient- frail, emaciated, with multiple comorbidities
  • Special Consideration: The Obturator Hernia

    1. 1. Special Consideration: The Obturator Hernia George Ferzli MD, FACS Staten Island University Hospital Staten Island, New York
    2. 2. Obturator Hernia <ul><li>1724 - described by Arnaud de Ronsil </li></ul><ul><li>1851 - First repair by Henry Obre </li></ul><ul><li>Approximately 0.1% of all hernias </li></ul>
    3. 3. Obturator Hernia <ul><li>9 : 1 female to male ratio </li></ul><ul><li>Typical patient is > 70 yrs of age </li></ul><ul><li>“ Little old lady’s hernia” </li></ul><ul><li>Up to 20% bilateral </li></ul>
    4. 4. <ul><li>Intestinal obstruction </li></ul><ul><ul><li>most common presentation </li></ul></ul><ul><li>Up to 70% mortality with strangulation </li></ul>CLINICAL PRESENTATION
    5. 5. CLINICAL PRESENTATION <ul><li>Howship-Romberg </li></ul><ul><ul><li>Pain in medial thigh with extension, abduction, and medial rotation of the hip </li></ul></ul><ul><ul><li>Pathognomonic but rarely found </li></ul></ul><ul><li>Hernia is not palpable externally </li></ul>
    6. 6. ANATOMY <ul><li>Formed by rami of the ischium and pubis </li></ul><ul><li>Bilaterally in anterolateral pelvic wall </li></ul><ul><li>Inferior to the acetabulum </li></ul>
    7. 9. Obturator Foramen <ul><li>Covered by obturator membrane </li></ul><ul><li>Internal orifice closed by preperitoneal fat </li></ul><ul><li>Contains obturator nerve and vessels </li></ul>
    8. 10. Obturator Foramen
    9. 11. MRI
    10. 12. CT SCAN
    11. 13. TAPP
    12. 14. INCARCERATED - TEP
    13. 15. STRANGULATED - TEP
    14. 16. SUMMARY <ul><li>Obturator hernia can be repaired laparoscopically </li></ul><ul><li>Bilateral inspection is mandatory </li></ul><ul><li>Bowel viability must be assessed </li></ul><ul><li>Mesh repair can be performed </li></ul>
    15. 17. QUESTION <ul><li>Should prosthetic mesh be used in the presence of intestinal perforation ? </li></ul>

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