術前診断し得た閉鎖孔ヘルニアの2症例

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  • TWO CASES OF OBUTURATOR HERNIA DIAGNOSED PREOPERATIVELY

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We report two cases of obuturator hernia which were properly diagnosed before surgery.<br> Case 1: An 81-year-old woman was referred to the hospital with symptoms of ileus and left inguinal abnormal sensation (Howship-Romberg sign). After hospitalization, she was under observation with the insertion of an ileus tube. Ileogram demonstrated an obstruction of the ileum above the left pubic bone. Abdominal CT revealed an incarcerated small intestine between the left pectineal muscle and internal obuturator muscle.<br> The patient was diagnosed as incarcerated left obuturator hernia, and laparotomy was performed. At surgery, it was found that the ileum incarcerated into the left obturator foramen. The jejunum and ileum were resected about 150cm's length because of necrosis of the small intestine and the hernia hilum was closed with direct suture.<br> Case 2: An 84-year-old woman was referred to the hospital with symptoms of ileus. After hospitalization, she was under observation with the insertion of an ileus tube. Ileogram showed obstruction of the ileum above the right pubic bone. Abdominal CT showed that the incarcerated small intestine was between the right pectineal muscle and interhal obturator muscle. Laparotomy was performed under a diagnosis of incarcerated right obturator hernia. At surgery, it was found that the ileum incarcerated into the right obturator foramen. The incarcerated ileum was resected because of necrosis of the intestinal wall. The hernia hilum was closed with direct suture.<br> It is essential to make the early and accurate diagnosis of obuturator hernia, because delayed operation often results in poor prognosis. Therefore, CT or MRI of the lower abdomen should be taken immediately by entertaining the probability of the disease, when we encounter aged female patients with intestinal obstruction.

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