Obturator hernia. Presentation of a series of ten cases in eleven years

Introduction: Obturator hernias are those in which the hernia sac and its contents are introduced into the obturator orifice and protrude through the canal of the same name. They are the most frequent hernias of those that affect the pelvic floor, but overall, they are a very rare variety since they account for less than 1 % of all hernias of the abdominal wall. Clinically, they usually present as a picture of mechanical intestinal obstruction, although they are a very infrequent cause of it (0.2-1.6 % of cases). Material and methods: Review of 10 cases of obturator hernia operated in our Service between november 2010 and march 2021. Results: All of our patients were women with a mean age of 85.2 years (range, 77-92). In all cases, the presentation was a small bowel occlusion. Two patients (20 %) had a history of significant weight loss. Computerized Tomography was performed in all of our patients, which was diagnostic of incarcerated obturator hernia in 80 % of the cases. In the remaining 20 % the diagnosis was femoral hernia. The laterality of the hernia was distributed 50 % on the right and left. All of the cases were operated on urgently through an infraumbilical median laparotomy. In 4 patients (40 %) an initial intestinal resection was necessary and, in another case, it was performed after 48 h. of the first laparotomy. Hernia repair was performed by simple suture in 8 cases (80 %) and with the placement of a mesh plug in two (20 %). The average hospital stay was 6.5 days (range, 3-12). Practically all of our cases presented postoperative morbidity of greater or lesser severity associated with pre-existing pathology. Mortality was 40 %. Conclusion: Obturator hernia is an infrequent cause of intestinal occlusion, but it must be suspected as a cause of it, especially when it occurs in elderly female patients. The diagnostic and therefore therapeutic delay make these hernias present a high morbidity and mortality.