Upload
george-s-ferzli
View
1.943
Download
15
Tags:
Embed Size (px)
DESCRIPTION
Citation preview
Special Consideration:The Obturator Hernia
George Ferzli MD, FACS
Staten Island University Hospital
Staten Island, New York
Obturator Hernia• 1724 - described by Arnaud de Ronsil
• 1851 - First repair by Henry Obre
• Approximately 0.1% of all hernias
Obturator Hernia• 9 : 1 female to male ratio
• Typical patient is > 70 yrs of age
• “Little old lady’s hernia”
• Up to 20% bilateral
• Intestinal obstruction– most common presentation
• Up to 70% mortality with strangulation
CLINICAL PRESENTATION
CLINICAL PRESENTATION
• Howship-Romberg
– Pain in medial thigh with extension, abduction, and medial rotation of the hip
– Pathognomonic but rarely found
• Hernia is not palpable externally
ANATOMY• Formed by rami of the ischium and
pubis
• Bilaterally in anterolateral pelvic wall
• Inferior to the acetabulum
Obturator Foramen
• Covered by obturator membrane
• Internal orifice closed by preperitoneal fat
• Contains obturator nerve and vessels
Obturator Foramen
MRI
CT SCAN
TAPP
INCARCERATED - TEP
STRANGULATED - TEP
SUMMARY• Obturator hernia can be repaired
laparoscopically
• Bilateral inspection is mandatory
• Bowel viability must be assessed
• Mesh repair can be performed
QUESTION Should prosthetic mesh be
used in the presence of intestinal perforation ?