A CASE OF METACHRONOUS BILATERAL OBTURATOR HERNIAS

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  • 異時性両側閉鎖孔ヘルニアの１例

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Abstract

We report a case of metachronous bilateral obturator hernia with contralateral onset occurring about three years after the primary onset in a patient of advanced age. A 97-year-old woman was admitted to our hospital for abdominal pain and vomiting since the day before. She had undergone laparotomy and hernioplasty for right obturator hernia about three years before this episode. Blood examination showed leukocytosis (10100/μl) and elevated C reactive protein level (0.46 mg/dl). Abdominal CT showed dilatation of the small intestine and incarcerated intestine between the pectineus and obturator muscles on the left side. With a diagnosis of left obturator hernia, we performed emergency laparotomy. In the view of the abdominal cavity, dilatation of small intestine and focal redness of the small intestinal wall were seen about 100 cm from the Treitz ligament. Neither perforation nor necrosis of the intestine was observed. We performed mesh plug hernioplasty for left obturator hernia with a preperitoneal approach. Her postoperative course was uneventful and she was discharged three weeks after the operation. Retrospectively, abdominal CT before the hernioplasty for right obturator hernia had shown soft tissue density between the pectineus and obturator muscles on the left side. Even in the treatment of old patients with obturator hernia, it is important to keep in mind the possibility of contralateral obturator hernia.

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